Healthcare Provider Details

I. General information

NPI: 1093552291
Provider Name (Legal Business Name): BRIAN MING-TZUEN HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 BONNEY RD
VIRGINIA BEACH VA
23452-2445
US

IV. Provider business mailing address

2744 ALAMEDA DR
VIRGINIA BEACH VA
23456-7503
US

V. Phone/Fax

Practice location:
  • Phone: 757-631-9700
  • Fax:
Mailing address:
  • Phone: 757-338-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419101
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: