Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 055065-1 | NY |
Y | 1223E0200X | Endodontist | 62032 | CA |
NPI | 1104055235 |
---|---|
Provider Name | Peiti Su |
First Address | Sacramento, CA 95864-3120 |
Second Address | Sacramento, CA 95864-1508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 03/03/2013 |