Provider Demographics
NPI:1841216561
Name:SU, JUI-MIN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JUI-MIN
Middle Name:
Last Name:SU
Suffix:
Gender:M
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 1:6817 RASPBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-7297
Mailing Address - Country:US
Mailing Address - Phone:713-303-0645
Mailing Address - Fax:
Practice Address - Street 1:4275 E. CONCOURS,
Practice Address - Street 2:SUITE 105
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5901
Practice Address - Country:US
Practice Address - Phone:951-736-0876
Practice Address - Fax:951-736-0876
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208141223P0700X
CA571381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics