Healthcare Provider Details

I. General information

NPI: 1114969680
Provider Name (Legal Business Name): PRISCILLA YING HSUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLAZA DRIVEWAY SUITE 630
LOS ANGELES CA
90095-3518
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9011
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax: 415-206-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64756
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA64756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: