Healthcare Provider Details

I. General information

NPI: 1295930527
Provider Name (Legal Business Name): VICTORIA JUI-YUN HSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 NORMAN DR SUITE 102
MANTECA CA
95336-5925
US

IV. Provider business mailing address

1144 NORMAN DR SUITE 102
MANTECA CA
95336-5925
US

V. Phone/Fax

Practice location:
  • Phone: 209-823-1152
  • Fax: 209-823-3376
Mailing address:
  • Phone: 209-823-1152
  • Fax: 209-823-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA97102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: