Healthcare Provider Details

I. General information

NPI: 1902467699
Provider Name (Legal Business Name): FANG-WEI RUBY HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VETERANS BLVD
REDWOOD CITY CA
94063-2612
US

IV. Provider business mailing address

9353 VALLEY BLVD STE C
ROSEMEAD CA
91770-1923
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-4777
  • Fax:
Mailing address:
  • Phone: 626-287-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY33129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: