Provider Demographics
NPI:1881232478
Name:SU, JIA HUI
Entity Type:Individual
Prefix:
First Name:JIA HUI
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6026
Mailing Address - Country:US
Mailing Address - Phone:917-346-8658
Mailing Address - Fax:
Practice Address - Street 1:7206 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6026
Practice Address - Country:US
Practice Address - Phone:718-489-9118
Practice Address - Fax:718-232-1904
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309326-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health