Provider Demographics
NPI:1184869463
Name:SU, LAN (DMD PHD)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31332 VIA COLINAS STE 109
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6779
Mailing Address - Country:US
Mailing Address - Phone:818-865-1039
Mailing Address - Fax:818-865-8375
Practice Address - Street 1:31332 VIA COLINAS STE 109
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6779
Practice Address - Country:US
Practice Address - Phone:818-865-1039
Practice Address - Fax:818-865-8375
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA469771223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87454Medicare UPIN