Provider Demographics
NPI:1821779430
Name:SU, LESLIE YUNG HSIN
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:YUNG HSIN
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W FAIRVIEW AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2955
Mailing Address - Country:US
Mailing Address - Phone:626-320-0235
Mailing Address - Fax:
Practice Address - Street 1:1327 S SAN GABRIEL BLVD APT B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3601
Practice Address - Country:US
Practice Address - Phone:626-573-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38573235Z00000X
NY35427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist