Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A67657 | CA |
N | 2086S0120X | Pediatric Surgery | M-14195 | ID |
NPI | 1609807064 |
---|---|
Provider Name | Dr. Wendy Tienhui Su |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 07/04/2021 |