Healthcare Provider Details

I. General information

NPI: 1285783621
Provider Name (Legal Business Name): RICHARD C HSU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 HUNTINGTON DR
SAN MARINO CA
91108-2642
US

IV. Provider business mailing address

2343 HUNTINGTON DR
SAN MARINO CA
91108-2642
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-5700
  • Fax: 626-463-1263
Mailing address:
  • Phone: 626-793-5700
  • Fax: 626-463-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: