Healthcare Provider Details

I. General information

NPI: 1336325786
Provider Name (Legal Business Name): JENNY CHIASHIANG HSU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18710 STARK AVE
CERRITOS CA
90703-8435
US

IV. Provider business mailing address

18710 STARK AVE
CERRITOS CA
90703-8435
US

V. Phone/Fax

Practice location:
  • Phone: 562-484-8628
  • Fax:
Mailing address:
  • Phone: 562-484-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number56561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: