Healthcare Provider Details

I. General information

NPI: 1265984199
Provider Name (Legal Business Name): RONALD H. HSU, DDS, MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 SE 192ND AVE SUITE 106
CAMAS WA
98607-7444
US

IV. Provider business mailing address

2115 SE 192ND AVE SUITE 106
CAMAS WA
98607-7444
US

V. Phone/Fax

Practice location:
  • Phone: 360-216-1130
  • Fax: 360-216-1125
Mailing address:
  • Phone: 360-216-1130
  • Fax: 360-216-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00010172
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD HSIEN-JUNG HSU
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 360-216-1130