Provider Demographics
NPI:1053741009
Name:SU, VI
Entity type:Individual
Prefix:
First Name:VI
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 WAIANUENUE AVE APT F245
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2541
Mailing Address - Country:US
Mailing Address - Phone:808-345-5138
Mailing Address - Fax:
Practice Address - Street 1:485 WAIANUENUE AVE APT F245
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2541
Practice Address - Country:US
Practice Address - Phone:808-345-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst