Healthcare Provider Details

I. General information

NPI: 1235541962
Provider Name (Legal Business Name): LEEYEN HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD STE 502
SHERMAN OAKS CA
91403-1817
US

IV. Provider business mailing address

200 W ARBOR DR # 8425
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-0200
  • Fax:
Mailing address:
  • Phone: 619-543-6268
  • Fax: 619-543-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA140050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: