Healthcare Provider Details

I. General information

NPI: 1356428643
Provider Name (Legal Business Name): BRIEN HSU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11458 KENYON WAY STE 120
RANCHO CUCAMONGA CA
91701-9219
US

IV. Provider business mailing address

11458 KENYON WAY STE 120
RANCHO CUCAMONGA CA
91701-9219
US

V. Phone/Fax

Practice location:
  • Phone: 909-941-2811
  • Fax: 909-941-7271
Mailing address:
  • Phone: 909-941-2811
  • Fax: 909-941-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: