Healthcare Provider Details

I. General information

NPI: 1063572782
Provider Name (Legal Business Name): EVELYN HSU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 MOWRY AVE STE A
FREMONT CA
94538-1630
US

IV. Provider business mailing address

2243 MOWRY AVE STE A
FREMONT CA
94538-1630
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-9777
  • Fax:
Mailing address:
  • Phone: 510-792-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: