Healthcare Provider Details

I. General information

NPI: 1851616486
Provider Name (Legal Business Name): MARK HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE 335
FREMONT CA
94538-5878
US

IV. Provider business mailing address

2500 MOWRY AVE STE 255
FREMONT CA
94538-1605
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1414
  • Fax:
Mailing address:
  • Phone: 510-248-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA117893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: