=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265984199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD H. HSU, DDS, MS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2016
-----------------------------------------------------
Last Update Date | 10/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2115 SE 192ND AVE SUITE 106
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-7444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-216-1130
-----------------------------------------------------
Fax | 360-216-1125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2115 SE 192ND AVE SUITE 106
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-7444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-216-1130
-----------------------------------------------------
Fax | 360-216-1125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. RONALD HSIEN-JUNG HSU
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 360-216-1130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DE00010172
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------