Healthcare Provider Details

I. General information

NPI: 1083831812
Provider Name (Legal Business Name): YIN HSU DMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128A TREMONT ST FL2
BOSTON MA
02108-4716
US

IV. Provider business mailing address

128A TREMONT ST FL2
BOSTON MA
02108-4716
US

V. Phone/Fax

Practice location:
  • Phone: 617-423-0505
  • Fax: 617-423-4259
Mailing address:
  • Phone: 617-423-0505
  • Fax: 617-423-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: