Provider Demographics
NPI:1770508111
Name:HSU, HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8622 GARVEY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3293
Mailing Address - Country:US
Mailing Address - Phone:626-280-6898
Mailing Address - Fax:626-280-6899
Practice Address - Street 1:8622 GARVEY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3293
Practice Address - Country:US
Practice Address - Phone:626-280-6898
Practice Address - Fax:626-280-6899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 51859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A518590Medicaid
CAA51859Medicare ID - Type Unspecified
CAG00431Medicare UPIN