Healthcare Provider Details

I. General information

NPI: 1508127994
Provider Name (Legal Business Name): YI-CHUN HSU PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2012
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 NEWCASTLE RD
STOCKTON CA
95215-9663
US

IV. Provider business mailing address

PO BOX 952
ELK GROVE CA
95759-0952
US

V. Phone/Fax

Practice location:
  • Phone: 626-217-5235
  • Fax:
Mailing address:
  • Phone: 626-217-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: