Provider Demographics
NPI:1598056996
Name:JEFFREY C. HSU PLLC
Entity Type:Organization
Organization Name:JEFFREY C. HSU PLLC
Other - Org Name:SPLENDENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:360-457-3303
Mailing Address - Street 1:430 TERRA EDEN ST
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9604
Mailing Address - Country:US
Mailing Address - Phone:360-374-6868
Mailing Address - Fax:360-374-6870
Practice Address - Street 1:430 TERRA EDEN ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9604
Practice Address - Country:US
Practice Address - Phone:360-374-6868
Practice Address - Fax:360-374-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty