Healthcare Provider Details

I. General information

NPI: 1659012615
Provider Name (Legal Business Name): J HSU DMD MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PUNAHOU ST
HONOLULU HI
96826-1027
US

IV. Provider business mailing address

1108 AUAHI ST APT 2108
HONOLULU HI
96814-4969
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIANA HSU
Title or Position: OWNER
Credential:
Phone: 617-275-6173