Provider Demographics
NPI:1265764351
Name:SU, HERBERT S (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:S
Last Name:SU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HERBERT
Other - Middle Name:S
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9611 GARVEY AVE
Mailing Address - Street 2:#124
Mailing Address - City:S EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1026
Mailing Address - Country:US
Mailing Address - Phone:626-448-2296
Mailing Address - Fax:626-448-2296
Practice Address - Street 1:9611 GARVEY AVE
Practice Address - Street 2:#124
Practice Address - City:S EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1026
Practice Address - Country:US
Practice Address - Phone:626-448-2296
Practice Address - Fax:626-448-2296
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADZ035034122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist