Healthcare Provider Details

I. General information

NPI: 1093038135
Provider Name (Legal Business Name): JOHN FU-TSUN HSU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 100
BEVERLY HILLS CA
90210-4308
US

IV. Provider business mailing address

416 N BEDFORD DR STE 100
BEVERLY HILLS CA
90210-4308
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1114
  • Fax: 310-275-1157
Mailing address:
  • Phone: 310-275-1114
  • Fax: 310-275-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20A11134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: