Healthcare Provider Details

I. General information

NPI: 1740292937
Provider Name (Legal Business Name): CHIH-CHIANG HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VALLHCS 11201 BENTON ST
LOMA LINDA CA
92357-0001
US

IV. Provider business mailing address

6820 RANCHGROVE RD
RIVERSIDE CA
92506-5307
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 951-780-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA38778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: