Healthcare Provider Details

I. General information

NPI: 1922312479
Provider Name (Legal Business Name): ELIZABETH HSU MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12728 19TH AVE SE STE 300
EVERETT WA
98208-6526
US

IV. Provider business mailing address

12728 19TH AVE SE STE 300
EVERETT WA
98208-6526
US

V. Phone/Fax

Practice location:
  • Phone: 425-420-1650
  • Fax: 509-633-1933
Mailing address:
  • Phone: 425-420-1650
  • Fax: 509-633-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number60536535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: