Charles Su, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42096 Issued in CA

Practice address

7275 E Southgate Dr
205
Sacramento, CA 95823-2628

Phone

(916) 399-1318

NPI assigned

Sep 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184723801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7275 E SOUTHGATE DR",
            "address_2": "205",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232628",
            "telephone_number": "916-399-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7275 E SOUTHGATE DR",
            "address_2": "205",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232628",
            "telephone_number": "916-399-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "CHARLES",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B42096",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina A. Stutz, M.A., PH.D.
• Dennis Michael Styne, M.D.
• Alice Ruiying Su, MD
• Arthur Y Su, MD
• Bonnie Su
• Michael Wei-Chih Su, MD, PHD
• Peggy Sin Nu Su, MD
• Peiti Su, DDS
• Wenda Su
• Erika Reyna Suarez Trejo

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.