Healthcare Provider Details

I. General information

NPI: 1114956430
Provider Name (Legal Business Name): JACK MING HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N COMMERCE AVE
FRONT ROYAL VA
22630-2660
US

IV. Provider business mailing address

120 N COMMERCE AVE
FRONT ROYAL VA
22630-2660
US

V. Phone/Fax

Practice location:
  • Phone: 540-635-0795
  • Fax:
Mailing address:
  • Phone: 540-635-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number220276
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101257635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: