Active NPI
Scott Su, PHD
- Clinical Psychologist
- Rancho Cucamonga, CA
National Provider Identifier
1043700842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30043
- Practice address
- 8300 Utica Ave Ste 245
Rancho Cucamonga, CA 91730-3852 - Phone
- (909) 247-5992
- NPI assigned
- May 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30043 | CA | Primary |
Addresses
Primary practice location
8300 Utica Ave Ste 245
Rancho Cucamonga, CA 91730-3852
Mailing address
8300 Utica Ave Ste 245
Rancho Cucamonga, CA 91730-3852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30043 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643068800000",
"number": "1043700842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8300 UTICA AVE STE 245",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8300 UTICA AVE STE 245",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303852",
"telephone_number": "909-247-5992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SU",
"first_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-16",
"last_updated": "2022-01-25",
"certification_date": "2022-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.