Provider Demographics
NPI:1902033913
Name:SU, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1043 ELM AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3295
Mailing Address - Country:US
Mailing Address - Phone:562-624-4943
Mailing Address - Fax:562-624-4974
Practice Address - Street 1:1043 ELM AVE STE 301
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3295
Practice Address - Country:US
Practice Address - Phone:562-624-4943
Practice Address - Fax:562-624-4974
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA114359207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty