Provider Demographics
NPI:1154484475
Name:HSU, DENISE DEFANG (LAC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:DEFANG
Last Name:HSU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3027 KAISER DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4745
Mailing Address - Country:US
Mailing Address - Phone:408-554-8620
Mailing Address - Fax:408-736-5738
Practice Address - Street 1:665 S KNICKERBOCKER DR STE 11
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1059
Practice Address - Country:US
Practice Address - Phone:408-739-9468
Practice Address - Fax:408-736-5738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC. 2888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4585928Medicaid