Healthcare Provider Details

I. General information

NPI: 1154909828
Provider Name (Legal Business Name): CHIA-YUAN HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 S GRAND BLVD
SAINT LOUIS MO
63118-3405
US

IV. Provider business mailing address

3721 S GRAND BLVD
SAINT LOUIS MO
63118-3405
US

V. Phone/Fax

Practice location:
  • Phone: 314-328-0144
  • Fax:
Mailing address:
  • Phone: 314-328-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023050310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: