Healthcare Provider Details

I. General information

NPI: 1386703023
Provider Name (Legal Business Name): JAY REUBEN HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 W WARM SPRINGS RD STE 210
LAS VEGAS NV
89113-3646
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-534-5464
  • Fax: 702-534-5465
Mailing address:
  • Phone: 702-216-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA91992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-33795
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15893
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: