Healthcare Provider Details

I. General information

NPI: 1053713933
Provider Name (Legal Business Name): ANDY HSU DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10212 5TH AVE NE SUITE 268
SEATTLE WA
98125-7452
US

IV. Provider business mailing address

10212 5TH AVE NE SUITE 268
SEATTLE WA
98125-7452
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-5111
  • Fax:
Mailing address:
  • Phone: 206-527-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number10544
License Number StateWA

VIII. Authorized Official

Name: DR. ANDY HSU
Title or Position: OWNER
Credential: DMD
Phone: 206-527-5111