Provider Demographics
NPI:1922312479
Name:HSU, ELIZABETH (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 19TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6526
Mailing Address - Country:US
Mailing Address - Phone:425-420-1650
Mailing Address - Fax:509-633-1933
Practice Address - Street 1:12728 19TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-420-1650
Practice Address - Fax:509-633-1933
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60536535207RE0101X, 207RE0101X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046902Medicaid