Provider Demographics
NPI:1194058669
Name:SU, HUAN (DDS)
Entity type:Individual
Prefix:
First Name:HUAN
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LAKE WASHINGTON BLVD N
Mailing Address - Street 2:APT A302
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2564
Mailing Address - Country:US
Mailing Address - Phone:425-988-4755
Mailing Address - Fax:
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:BUILDING C SUITE 22
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-752-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60101496122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist