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General NPI Number Information
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NPI Number | 1508148941
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Entity Type | Organization
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Legal Business Name | JUSTIN HU, O.D., INCORPORATED
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 1103 FAIR OAKS AVE
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3311
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Country | US
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Telephone | 626-441-0770
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Fax | 626-441-0990
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Provider Business Mailing Address
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Address Line | 1103 FAIR OAKS AVE
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3311
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Country | US
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Telephone | 626-441-0770
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Fax | 626-441-0990
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Authorized Official
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Title or Position | OWNER, OPTOMETRIST
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Name | DR. JUSTIN HU
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Credential | O.D.
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Telephone | 626-441-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13761 TLG
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License Number State | CA
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