Healthcare Provider Details

I. General information

NPI: 1891977757
Provider Name (Legal Business Name): DR. JERRY Y HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BLAKE WILBUR DRIVE
STANFORD CA
94305
US

IV. Provider business mailing address

875 BLAKE WILBUR DRIVE
STANFORD CA
94305
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-7621
  • Fax: 650-725-9113
Mailing address:
  • Phone: 650-723-7621
  • Fax: 650-725-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA94762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: