Provider Demographics
NPI:1538056114
Name:HSU, JOHAN
Entity type:Individual
Prefix:
First Name:JOHAN
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BLUE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2411
Mailing Address - Country:US
Mailing Address - Phone:909-859-5759
Mailing Address - Fax:
Practice Address - Street 1:NELLIS AFB
Practice Address - Street 2:4700 LAS VEGAS BLVD
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:909-859-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program