Provider Demographics
NPI:1073592598
Name:HSU, TIEN-SHENG (MD)
Entity Type:Individual
Prefix:
First Name:TIEN-SHENG
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4056
Mailing Address - Country:US
Mailing Address - Phone:909-981-6211
Mailing Address - Fax:909-981-6228
Practice Address - Street 1:980 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4056
Practice Address - Country:US
Practice Address - Phone:909-981-6211
Practice Address - Fax:909-981-6228
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337870Medicaid
CA00A337870Medicaid