Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2166C | AS |
NPI | 1043666928 |
---|---|
Provider Name | Ms. Hong Su |
First Address | Pago Pago, AS 96799-9994 |
Second Address | Pago Pago, AS 96799-9994 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 10/05/2016 |