Yuehang Su, DMD
Individual provider Active NPI General Practice Dentistry · Joint Base Andrews, MD
NPI 1780117853 · NPPES record last updated Apr 6, 2017
Key facts
- NPI
- 1780117853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401415258 (VA)
- Practice address
- 1601 California Ave
Joint Base Andrews, MD 20762 - Phone
- (240) 857-5029
- NPI assigned
- Apr 6, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181227002325 | NC | Order and Referring Only - Dentist |
2961747639 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401415258 | VA | Yes |
Addresses
Primary practice location
1601 California Ave
Joint Base Andrews, MD 20762
Mailing address
5750 Dow Ave Apt 525
Alexandria, VA 22304-4079
Phone (321) 276-4231
Other providers in Joint Base Andrews, MD
- Howard Der-Haw Lee
- Annie Nguyen
- Diosdado Pangilinan
- Christopher Matthew Scott
- Norman Edward Stone III
- Rose Marie Wojcik
- Songxuan Zhou Niemtzow
All providers in Joint Base Andrews, MD · General Practice Dentistry in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.