1942211347 NPI number — DR. EUGENE MING SU DC, MAOM

Table of content: DR. EUGENE MING SU DC, MAOM (NPI 1942211347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942211347 NPI number — DR. EUGENE MING SU DC, MAOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SU
Provider First Name:
EUGENE
Provider Middle Name:
MING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, MAOM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942211347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44330 PREMIER PLZ
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-5070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-723-9355
Provider Business Mailing Address Fax Number:
703-723-6647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 SW 74TH ST
Provider Second Line Business Practice Location Address:
#220
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-692-9362
Provider Business Practice Location Address Fax Number:
703-723-6647
Provider Enumeration Date:
08/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  004126442205 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 10465 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)