Healthcare Provider Details

I. General information

NPI: 1952720013
Provider Name (Legal Business Name): DEREK YU HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 N WESTERN AVE
LOS ANGELES CA
90004-2602
US

IV. Provider business mailing address

630 MEYER LN UNIT A
REDONDO BEACH CA
90278-5262
US

V. Phone/Fax

Practice location:
  • Phone: 805-338-0524
  • Fax:
Mailing address:
  • Phone: 805-338-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA140476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: