Individual provider Active NPI

Stephen Kwansia Su, D.P.M.

  • Podiatrist
  • Orange, CA
National Provider Identifier
1881721926
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E2174 Issued in CA
Practice address
715 E Chapman
Orange, CA 92866-1620
Phone
(714) 532-6357
Fax
(714) 532-4144
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E2174 CA Primary

Addresses

Primary practice location

715 E Chapman
Orange, CA 92866-1620

Mailing address

P.O. Box 2517
Anaheim, CA 92814-0517
Phone (714) 532-6357

Other identifiers 1

IdentifierTypeStateIssuer
000E21740MedicaidCA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100809000129 CA Practitioner - Podiatry 4183757388 Receives reassigned benefits from 1 practitioner
Practice locations: Orange, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E2174CAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Stephen Su, D.P.M. PastSince Jan 1, 1973 Accepting new patients
Northland Hearing Centers, Inc. PastSince Apr 1, 2023 Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1881721926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2517",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928140517",
            "telephone_number": "714-532-6357",
            "fax_number": "714-532-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E CHAPMAN",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928661620",
            "telephone_number": "714-532-6357",
            "fax_number": "714-532-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "STEPHEN",
        "middle_name": "KWANSIA",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E2174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E21740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.