Provider Demographics
NPI:1497979629
Name:KENNETH K HSU M.D., INC
Entity Type:Organization
Organization Name:KENNETH K HSU M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-322-2329
Mailing Address - Street 1:PO BOX 20633
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0633
Mailing Address - Country:US
Mailing Address - Phone:661-322-2329
Mailing Address - Fax:
Practice Address - Street 1:511 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1201
Practice Address - Country:US
Practice Address - Phone:661-322-2329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA505770207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505770Medicaid
CABH1526043OtherDRUG LICENSE
CABH1526043OtherDRUG LICENSE
CA5563470001Medicare NSC
CABC872Medicare PIN
CAE48259Medicare UPIN
CA110191095Medicare PIN