Healthcare Provider Details

I. General information

NPI: 1801280953
Provider Name (Legal Business Name): POWEN HSUEH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79430 HIGHWAY 111 STE 102
LA QUINTA CA
92253-4549
US

IV. Provider business mailing address

79430 HIGHWAY 111 STE 102
LA QUINTA CA
92253-4549
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7793
  • Fax:
Mailing address:
  • Phone: 951-827-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34016727
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1614
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34016727
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A18688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: