| NPI | 1407177785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MING-TA SU Provider 818-551-0026 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA A91343) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-06-21 |