Healthcare Provider Details

I. General information

NPI: 1063505253
Provider Name (Legal Business Name): CHI WAN HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 NW 31ST
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

2809 NW 31ST
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-7474
  • Fax: 405-942-2518
Mailing address:
  • Phone: 405-942-7474
  • Fax: 405-942-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12901
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: