Healthcare Provider Details

I. General information

NPI: 1164052593
Provider Name (Legal Business Name): STANLEY LIWEN HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1607
US

IV. Provider business mailing address

PO BOX 4053
DIAMOND BAR CA
91765-0053
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-5551
  • Fax:
Mailing address:
  • Phone: 909-013-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH59575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: