Healthcare Provider Details

I. General information

NPI: 1073611224
Provider Name (Legal Business Name): SHUN-CHING HSU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 ATHENS HWY #207
GRAYSON GA
30017-1710
US

IV. Provider business mailing address

6307 ROBINS TRCE
STONE MOUNTAIN GA
30087-4979
US

V. Phone/Fax

Practice location:
  • Phone: 678-512-0261
  • Fax:
Mailing address:
  • Phone: 770-498-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: