Provider Demographics
NPI:1619916004
Name:HSU, CONNIE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHENGUANG
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13575 W INDIAN SCHOOL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4906
Mailing Address - Country:US
Mailing Address - Phone:623-512-4310
Mailing Address - Fax:602-512-4311
Practice Address - Street 1:13575 W INDIAN SCHOOL RD STE 200
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4906
Practice Address - Country:US
Practice Address - Phone:623-512-4310
Practice Address - Fax:602-512-4311
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35528207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ186990Medicaid
AZ186990Medicaid
AZZ132144Medicare PIN