Healthcare Provider Details

I. General information

NPI: 1316095292
Provider Name (Legal Business Name): CHARLES C. HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHUNG-PANG HSU M.D.

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-3910
  • Fax:
Mailing address:
  • Phone: 909-427-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA41423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: