Healthcare Provider Details

I. General information

NPI: 1538512389
Provider Name (Legal Business Name): YU JU HSU ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 8TH AVE
BROOKLYN NY
11220-1516
US

IV. Provider business mailing address

918 TAIRILIN DR UNIT#A
LAKE CITY SC
29560-4914
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-1233
  • Fax: 718-972-1277
Mailing address:
  • Phone: 734-834-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704303214
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: