Provider Demographics
NPI:1750304093
Name:HSU, WENDY C (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:C
Last Name:HSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:MSLM4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000444952085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5386HSOtherBLUE SHIELD
WA0039587OtherL&I
WA1750304093OtherIDAHO MEDICAID
WA7124827OtherAETNA
WAPOO331005OtherRAILROAD MEDICARE
WA1750304093OtherMONTANA MEDICAID
WA8463556Medicaid
WA7124827OtherAETNA
WA8861005Medicare PIN
WA8862590Medicare PIN
WA1750304093OtherIDAHO MEDICAID