Healthcare Provider Details

I. General information

NPI: 1629198122
Provider Name (Legal Business Name): RONALD HSIEN-JUNG HSU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2115 SE 192ND AVE STE 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 NumberD10172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: