Provider Demographics
NPI:1881801793
Name:SU, JUNG-CHIA
Entity type:Individual
Prefix:MS
First Name:JUNG-CHIA
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3278 KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3568
Mailing Address - Country:US
Mailing Address - Phone:312-451-1055
Mailing Address - Fax:
Practice Address - Street 1:3550 MOWRY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1460
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:510-745-9152
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program