Provider Demographics
NPI:1487722823
Name:SU, KUAN WEN (MD)
Entity type:Individual
Prefix:
First Name:KUAN
Middle Name:WEN
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:841 W VALLEY BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3251
Mailing Address - Country:US
Mailing Address - Phone:626-282-8441
Mailing Address - Fax:626-282-2759
Practice Address - Street 1:841 W VALLEY BLVD
Practice Address - Street 2:STE 107
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3251
Practice Address - Country:US
Practice Address - Phone:626-282-8441
Practice Address - Fax:626-282-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC 42531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine