NPIMap

Individual provider Active NPI

Derrick Weison Su, MD

  • Specialist
  • Fountain Valley, CA
National Provider Identifier
1740569789
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A125217 Issued in CA
Practice address
11180 Warner Ave Ste 351
Fountain Valley, CA 92708-7516
Phone
(714) 698-0300
Fax
(714) 698-0313
NPI assigned
Aug 9, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A125217 CA Primary

Addresses

Primary practice location

11180 Warner Ave Ste 351
Fountain Valley, CA 92708-7516

Mailing address

11180 Warner Ave
Ste 351
Fountain Valley, CA 92708-7516
Phone (714) 698-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170728002125 CA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2365713062 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Boston University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11180 Warner Ave
Suite 351
Fountain Valley, CA 92708-7516
Phone (714) 698-0300

1211 W la Palma Ave
Suite 103
Anaheim, CA 92801-2810
Phone (714) 999-1465

1245 Wilshire Blvd
Suite 303
Los Angeles, CA 90017-4803
Phone (213) 977-1214

23961 Calle de la Magdalena
Suite 501
Laguna Hills, CA 92653-7622
Phone (951) 371-2411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A125217CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Compassionate Cancer Care Medical Group, Inc. Specialist CurrentSince Aug 21, 2017 Accepting new patients
Los Angeles Hematology-Oncology Medical Group CurrentSince Jun 1, 2024 Accepting new patients
Los Angeles Hematology-Oncology Medical Group Specialist Current Accepting new patients
Los Angeles Hematology-Oncology Medical Group CurrentSince Jun 1, 2024 Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients

Locations

1211 W La Palma Ave
Ste 103
Anaheim, CA 92801
Phone (714) 535-3660

260 E Ontario Ave
Ste 101
Corona, CA 92879
Phone (951) 268-7746

11180 Warner Ave
Ste 351
Fountain Vly, CA 92708
Phone (714) 210-2300

1505 Wilson Ter
Ste 200
Glendale, CA 91206
Phone (818) 243-0477

23961 Calle de la Magdalena
Ste 501
Laguna Hills, CA 92653
Phone (714) 698-0300

3801 Katella Ave
Ste 207
Los Alamitos, CA 90720
Phone (562) 598-9745

1245 Wilshire Blvd
Ste 303
Los Angeles, CA 90017
Phone (213) 977-1214

4500 Brockton Ave
Ste 107
Riverside, CA 92501
Phone (951) 276-2760

15211 Vanowen St
Ste 201
Van Nuys, CA 91405
Phone (818) 574-3798

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1740569789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11180 WARNER AVE",
            "address_2": "STE 351",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927087516",
            "telephone_number": "714-698-0300",
            "fax_number": "714-698-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11180 WARNER AVE STE 351",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927087516",
            "telephone_number": "714-698-0300",
            "fax_number": "714-698-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "DERRICK",
        "middle_name": "WEISON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-09",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A125217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.