Provider Demographics
NPI:1538512389
Name:HSU, YU JU (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:YU JU
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 TAIRILIN DR
Mailing Address - Street 2:UNIT#A
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4914
Mailing Address - Country:US
Mailing Address - Phone:734-834-7406
Mailing Address - Fax:
Practice Address - Street 1:4506 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1516
Practice Address - Country:US
Practice Address - Phone:718-972-1233
Practice Address - Fax:718-972-1277
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303214363L00000X
NY431024363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner