Provider Demographics
NPI:1184719668
Name:SU, CATHERINE KAILIN (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:KAILIN
Last Name:SU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-977-4673
Mailing Address - Fax:408-729-9943
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-977-4673
Practice Address - Fax:408-729-9943
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA659202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A659200Medicaid
CA00A65920Medicare PIN
CAG69624Medicare UPIN