Healthcare Provider Details

I. General information

NPI: 1740303031
Provider Name (Legal Business Name): HSU PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 S WOLFE RD SUITE 216
SUNNYVALE CA
94087-4867
US

IV. Provider business mailing address

1698 S WOLFE RD SUITE 216
SUNNYVALE CA
94087-4867
US

V. Phone/Fax

Practice location:
  • Phone: 408-617-0000
  • Fax:
Mailing address:
  • Phone: 408-617-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number47266
License Number StateCA

VIII. Authorized Official

Name: SHELTON HSU
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 408-617-0000