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General NPI Number Information
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NPI Number | 1598011355
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Entity Type | Organization
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Legal Business Name | SHUN HSU DDS LLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 1132 ATHENS HWY SUITE 207
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City | GRAYSON
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State | GA
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Zip | 30017-1710
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Country | US
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Telephone | 678-512-0261
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Fax | 678-512-0262
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Provider Business Mailing Address
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Address Line | 6307 ROBINS TRCE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-4979
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Country | US
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Telephone | 678-512-0261
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Fax | 678-512-0262
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | SHUN CHING HSU
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Credential | DDS
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Telephone | 678-512-0261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN012882
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License Number State | GA
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