Provider Demographics
NPI:1235296047
Name:HSU, SIU (DDS)
Entity Type:Individual
Prefix:
First Name:SIU
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 1:10801 MAIN ST
Mailing Address - Street 2:STE 500 AND 600
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-352-2500
Mailing Address - Fax:703-352-4500
Practice Address - Street 1:10801 MAIN ST
Practice Address - Street 2:STE 500 AND 600
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-352-2500
Practice Address - Fax:703-352-4500
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14637Medicaid