Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 237395 | NY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A109113 | CA |
NPI | 1063690782 |
---|---|
Provider Name | Dr. Brian Su |
First Address | Larkspur, CA 94939-1141 |
Second Address | Larkspur, CA 94939-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 17/08/2011 |