Provider Demographics
NPI:1598895245
Name:SU, RONG YEH
Entity Type:Individual
Prefix:MR
First Name:RONG
Middle Name:YEH
Last Name:SU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W VALLEY BLVD
Mailing Address - Street 2:#65
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3200
Mailing Address - Country:US
Mailing Address - Phone:626-576-1296
Mailing Address - Fax:626-576-1296
Practice Address - Street 1:701 W VALLEY BLVD
Practice Address - Street 2:#65
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3200
Practice Address - Country:US
Practice Address - Phone:626-576-1296
Practice Address - Fax:626-576-1296
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist