Healthcare Provider Details

I. General information

NPI: 1558652701
Provider Name (Legal Business Name): JEFFREY JOHN HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLAZA STE 630
LOS ANGELES CA
90095-1454
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: 310-825-9012
Mailing address:
  • Phone: 310-301-8732
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA124119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: