Healthcare Provider Details

I. General information

NPI: 1669409827
Provider Name (Legal Business Name): WEI-LI HSU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 10TH AVE STE 178
SALT LAKE CITY UT
84103-2885
US

IV. Provider business mailing address

324 E 10TH AVE STE 178
SALT LAKE CITY UT
84103-2885
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-8510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A 10945
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12654564-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: