Provider Demographics
NPI:1164401444
Name:HSU, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
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 1:757 E HOLLAND AVE
Mailing Address - Street 2:NORTHWEST DERMATOLOGY
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-444-6367
Mailing Address - Fax:509-444-6371
Practice Address - Street 1:757 E HOLLAND AVE
Practice Address - Street 2:NORTHWEST DERMATOLOGY
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-444-6367
Practice Address - Fax:509-444-6371
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033906207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKQ241OtherBLUE CROSS IDAHO
WA1115013Medicaid
WAP00061071Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WAKQ241OtherBLUE CROSS IDAHO
WAAB26780Medicare ID - Type Unspecified
WA1115013Medicaid