Provider Demographics
NPI:1316283856
Name:SU, SHYH MIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHYH MIN
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BANDOL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657-0136
Mailing Address - Country:US
Mailing Address - Phone:949-720-8775
Mailing Address - Fax:
Practice Address - Street 1:183 HELIX
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1157
Practice Address - Country:US
Practice Address - Phone:949-932-0430
Practice Address - Fax:949-720-8775
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30805207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease