Healthcare Provider Details

I. General information

NPI: 1891892584
Provider Name (Legal Business Name): CHESTER Y HSU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 01/22/2021
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 RANDLEMAN RD
GREENSBORO NC
27406-5153
US

IV. Provider business mailing address

7807 FRONT NINE DR
STOKESDALE NC
27357-9407
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-2758
  • Fax: 910-338-3031
Mailing address:
  • Phone: 916-761-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: