Provider Demographics
NPI:1750581930
Name:SU, TIEN I KARLEEN (MD)
Entity type:Individual
Prefix:
First Name:TIEN I
Middle Name:KARLEEN
Last Name:SU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIEN-I
Other - Middle Name:KARLEEN
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12456 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1005
Mailing Address - Country:US
Mailing Address - Phone:562-758-6600
Mailing Address - Fax:562-758-6709
Practice Address - Street 1:12456 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-758-6600
Practice Address - Fax:562-758-6709
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98890207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A988900Medicaid
CAEL583ZMedicare PIN
CA00A988900Medicaid