Healthcare Provider Details

I. General information

NPI: 1740416783
Provider Name (Legal Business Name): YUEH JU HSIAO D.M.D, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3695 MANOR RD
BETHLEHEM PA
18020-8609
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS037678
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS037678
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: