Provider Demographics
NPI:1932547882
Name:SU AND CHANG DERMATOLOGY ASSOCIATES, APMC
Entity Type:Organization
Organization Name:SU AND CHANG DERMATOLOGY ASSOCIATES, APMC
Other - Org Name:VERDUGO DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-528-5199
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91102-0629
Mailing Address - Country:US
Mailing Address - Phone:310-528-5199
Mailing Address - Fax:
Practice Address - Street 1:3600 N VERDUGO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1219
Practice Address - Country:US
Practice Address - Phone:310-528-5199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty