Healthcare Provider Details

I. General information

NPI: 1851659031
Provider Name (Legal Business Name): TING-WEI HENRY HSU D.M.D, M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 RURAL AVE
WILLIAMSPORT PA
17701-3073
US

IV. Provider business mailing address

852 RURAL AVE
WILLIAMSPORT PA
17701-3073
US

V. Phone/Fax

Practice location:
  • Phone: 626-466-8447
  • Fax:
Mailing address:
  • Phone: 626-466-8447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9213
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS040245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: