MEDICARE: KEVIN HSU DMD

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	1223G0001X	General Practice Dentistry	21760	MA

General Provider Information

NPI Number	:	1831316744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN HSU DMD

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:	315-454-8650

Provider Business Practice Location Address
First Line	:	25 FAUNCE CORNER RD # A
Second Line	:
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-4202
Country	:	US
Telephone Number	:	508-999-5558
Fax Number	:	508-999-5060

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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