Active NPI
Peiti Su, DDS
- Endodontics
- Sacramento, CA
National Provider Identifier
1104055235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 62032
- Practice address
- 1721 La Playa Way
Sacramento, CA 95864-1508 - Phone
- (916) 432-3431
- NPI assigned
- Jul 10, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 62032 | CA | Primary |
| Endodontics | 1223E0200X | 055065-1 | NY |
Addresses
Primary practice location
1721 La Playa Way
Sacramento, CA 95864-1508
Mailing address
4300 Berrendo Dr
Sacramento, CA 95864-3120
Phone (916) 432-3431
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150901002595 | CA | Order and Referring Only - Dentist | 2668788969 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055065-1 | NY | MD | Endodontist |
| 62032 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362268800000",
"number": "1104055235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 BERRENDO DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958643120",
"telephone_number": "916-432-3431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1721 LA PLAYA WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958641508",
"telephone_number": "916-432-3431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SU",
"first_name": "PEITI",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-10",
"last_updated": "2013-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "62032",
"primary": true
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "055065-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.