Provider Demographics
NPI:1639369192
Name:SU, NING MIAO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NING MIAO
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5716
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-5716
Mailing Address - Country:US
Mailing Address - Phone:949-653-5868
Mailing Address - Fax:949-653-5860
Practice Address - Street 1:14200 CULVER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0312
Practice Address - Country:US
Practice Address - Phone:949-653-5868
Practice Address - Fax:949-653-5860
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice