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General NPI Number Information
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NPI Number | 1114003670
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Entity Type | Organization
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Legal Business Name | SERENA HSU DDS MS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 11458 KENYON WAY SUITE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701
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Country | US
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Telephone | 909-941-2811
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 273
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City | VERDUGO CITY
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State | CA
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Zip | 91046
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Country | US
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Telephone | 909-941-2811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, ORTHODONTIST
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Name | MS. SERENA HSU
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Credential | D.D.S., M.S.
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Telephone | 909-941-2811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 41090
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License Number State | CA
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