Healthcare Provider Details

I. General information

NPI: 1083817399
Provider Name (Legal Business Name): ANDREW S HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 4TH AVE STE 404
CHULA VISTA CA
91910-4413
US

IV. Provider business mailing address

480 4TH AVE SUITE 404
CHULA VISTA CA
91910-4410
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-7470
  • Fax: 619-425-7470
Mailing address:
  • Phone: 619-425-7470
  • Fax: 619-425-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA108956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: