Provider Demographics
NPI:1073611224
Name:HSU, SHUN-CHING (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHUN-CHING
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 ROBINS TRCE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4979
Mailing Address - Country:US
Mailing Address - Phone:770-498-3645
Mailing Address - Fax:
Practice Address - Street 1:1132 ATHENS HWY
Practice Address - Street 2:#207
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1710
Practice Address - Country:US
Practice Address - Phone:678-512-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100292OtherAVESIS
GA9180517OtherDORAL
GA684739693BMedicaid