Healthcare Provider Details

I. General information

NPI: 1164401444
Provider Name (Legal Business Name): BENJAMIN HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E HOLLAND AVE NORTHWEST DERMATOLOGY
SPOKANE WA
99218-1257
US

IV. Provider business mailing address

757 E HOLLAND AVE NORTHWEST DERMATOLOGY
SPOKANE WA
99218-1257
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-6367
  • Fax: 509-444-6371
Mailing address:
  • Phone: 509-444-6367
  • Fax: 509-444-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00033906
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD00033906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: