Provider Demographics
NPI:1972715134
Name:SU, QUINN (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUINN
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 VAN NESS AVE
Mailing Address - Street 2:406
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2529
Mailing Address - Country:US
Mailing Address - Phone:415-922-2298
Mailing Address - Fax:415-922-0298
Practice Address - Street 1:2107 VAN NESS AVE
Practice Address - Street 2:406
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2529
Practice Address - Country:US
Practice Address - Phone:415-922-2298
Practice Address - Fax:415-922-0298
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice