Healthcare Provider Details

I. General information

NPI: 1184693285
Provider Name (Legal Business Name): KANG HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 410
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 410
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-9401
  • Fax: 714-639-7095
Mailing address:
  • Phone: 714-639-9401
  • Fax: 714-639-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA73026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: