Provider Demographics
NPI:1265868418
Name:HSU, JOHANAN Y (MD)
Entity type:Individual
Prefix:
First Name:JOHANAN
Middle Name:Y
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 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 400 MOB3
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3501
Mailing Address - Country:US
Mailing Address - Phone:281-275-0800
Mailing Address - Fax:281-275-0801
Practice Address - Street 1:16605 SOUTHWEST FWY
Practice Address - Street 2:SUITE 400 MOB3
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3501
Practice Address - Country:US
Practice Address - Phone:281-275-0800
Practice Address - Fax:281-275-0801
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8511207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368064701Medicaid
TX8GJ458OtherBCBS
TX8GJ458OtherBCBS