Provider Demographics
NPI:1497444996
Name:HSU, AUDREE JANE
Entity Type:Individual
Prefix:
First Name:AUDREE
Middle Name:JANE
Last Name:HSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20915 GRANITE WELLS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1359
Mailing Address - Country:US
Mailing Address - Phone:626-715-8815
Mailing Address - Fax:
Practice Address - Street 1:20915 GRANITE WELLS DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1359
Practice Address - Country:US
Practice Address - Phone:626-715-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program