Healthcare Provider Details

I. General information

NPI: 1104285600
Provider Name (Legal Business Name): MISS AMY HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 VILLAGE CIRCLE DR
TEMPLE CITY CA
91780-3355
US

IV. Provider business mailing address

5214 VILLAGE CIRCLE DR
TEMPLE CITY CA
91780-3355
US

V. Phone/Fax

Practice location:
  • Phone: 626-823-8269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: