Provider Demographics
NPI:1386656726
Name:HSU, GOETHE ISSAC (MD)
Entity Type:Individual
Prefix:
First Name:GOETHE
Middle Name:ISSAC
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 1:12651 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4563
Mailing Address - Country:US
Mailing Address - Phone:562-861-3111
Mailing Address - Fax:562-861-9721
Practice Address - Street 1:12651 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4563
Practice Address - Country:US
Practice Address - Phone:562-861-3111
Practice Address - Fax:562-861-9721
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15800OtherCORPORATION GROUP NUMBER
CAWA65018BMedicare PIN
CAW15800OtherCORPORATION GROUP NUMBER