Healthcare Provider Details

I. General information

NPI: 1114082005
Provider Name (Legal Business Name): MS. LYDIA HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 STOCKTON STREET
SAN FRANCISCO CA
94133-3354
US

IV. Provider business mailing address

1520 STOCKTON STREET
SAN FRANCISCO CA
94133-3354
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-9686
  • Fax: 415-433-4726
Mailing address:
  • Phone: 415-391-9686
  • Fax: 415-433-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number190909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: