Provider Demographics
NPI:1639229461
Name:HSU, TING TING (OD)
Entity Type:Individual
Prefix:
First Name:TING
Middle Name:TING
Last Name:HSU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SAN CLEMENTE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6604
Mailing Address - Country:US
Mailing Address - Phone:310-377-3569
Mailing Address - Fax:
Practice Address - Street 1:1760 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5902
Practice Address - Country:US
Practice Address - Phone:310-540-2970
Practice Address - Fax:310-540-1312
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU94723Medicare UPIN
CAWOP11999Medicare ID - Type Unspecified