Provider Demographics
NPI:1063690782
Name:SU, BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-925-8200
Mailing Address - Fax:415-464-5480
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-925-8200
Practice Address - Fax:415-464-5480
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237395207XS0117X
CAA109113207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine