Provider Demographics
NPI:1508013699
Name:HSU, TIFFANY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:B
Last Name:HSU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BINKHSIAN
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DD,S
Mailing Address - Street 1:19623 STALLION CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4230
Mailing Address - Country:US
Mailing Address - Phone:626-512-5620
Mailing Address - Fax:
Practice Address - Street 1:19623 STALLION CIR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4230
Practice Address - Country:US
Practice Address - Phone:626-512-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice