Healthcare Provider Details

I. General information

NPI: 1386863918
Provider Name (Legal Business Name): G-JEN HSU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 SAN RAMON RD
DUBLIN CA
94568-3242
US

IV. Provider business mailing address

7226 SAN RAMON RD
DUBLIN CA
94568-3242
US

V. Phone/Fax

Practice location:
  • Phone: 925-551-3396
  • Fax: 925-551-3786
Mailing address:
  • Phone: 925-551-3396
  • Fax: 925-551-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: