Provider Demographics
NPI:1245857895
Name:HSU, MICHAEL REN-JIEH (DDS, MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:REN-JIEH
Last Name:HSU
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7942 BRIGHTLIGHT PL
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7962
Mailing Address - Country:US
Mailing Address - Phone:240-678-2670
Mailing Address - Fax:
Practice Address - Street 1:6351 OKLAHOMA RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6620
Practice Address - Country:US
Practice Address - Phone:410-795-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16922122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics