Healthcare Provider Details

I. General information

NPI: 1467378604
Provider Name (Legal Business Name): KEVIN STANFORD HSUEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E JULIAN ST FL 2
SAN JOSE CA
95112-4007
US

IV. Provider business mailing address

415 E TAYLOR ST APT 1063
SAN JOSE CA
95112-7025
US

V. Phone/Fax

Practice location:
  • Phone: 408-457-7101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: