Provider Demographics
NPI:1225554470
Name:HSU, I-KUAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:I-KUAN
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WHITEHALL RD APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6192
Mailing Address - Country:US
Mailing Address - Phone:650-703-2513
Mailing Address - Fax:
Practice Address - Street 1:100 SMITH RANCH RD FL 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5552
Practice Address - Country:US
Practice Address - Phone:415-492-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA76653OtherCALIFORNIA STATE BOARD OF PHARMACY