Provider Demographics
NPI:1619154069
Name:HSU, PEICHI (DDS)
Entity Type:Individual
Prefix:MS
First Name:PEICHI
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15124 36TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6148
Mailing Address - Country:US
Mailing Address - Phone:425-948-6268
Mailing Address - Fax:
Practice Address - Street 1:4310 COLBY AVE STE 300
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2338
Practice Address - Country:US
Practice Address - Phone:800-360-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000111701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice