Healthcare Provider Details

I. General information

NPI: 1316959760
Provider Name (Legal Business Name): FRED S HSU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13344 1ST AVE NE SUITE 205
SEATTLE WA
98125-3059
US

IV. Provider business mailing address

13344 1ST AVE NE SUITE 205
SEATTLE WA
98125-3059
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-7575
  • Fax: 206-364-7589
Mailing address:
  • Phone: 206-364-7575
  • Fax: 206-364-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00009870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: