MEDICARE: YU JU HSU ACNPC-AG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704303214	MI
2	363LA2100X	Acute Care Nurse Practitioner	431024	NY

General Provider Information

NPI Number	:	1538512389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YU JU HSU ACNPC-AG

Provider Business Mailing Address
First Line	:	918 TAIRILIN DR
Second Line	:	UNIT#A
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4914
Country	:	US
Telephone Number	:	734-834-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	4506 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1516
Country	:	US
Telephone Number	:	718-972-1233
Fax Number	:	718-972-1277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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