Healthcare Provider Details

I. General information

NPI: 1164403556
Provider Name (Legal Business Name): SUSAN PI-SHIAN HSU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 PALMETTO AVE STE B
PACIFICA CA
94044-2796
US

IV. Provider business mailing address

2014 PALMETTO AVE STE B
PACIFICA CA
94044-2796
US

V. Phone/Fax

Practice location:
  • Phone: 650-359-2231
  • Fax: 650-359-2305
Mailing address:
  • Phone: 650-359-2231
  • Fax: 650-359-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8365TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: