Provider Demographics
NPI:1750392296
Name:HSU, WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WALKER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4135
Mailing Address - Country:US
Mailing Address - Phone:212-226-8866
Mailing Address - Fax:212-226-2289
Practice Address - Street 1:125 WALKER ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4135
Practice Address - Country:US
Practice Address - Phone:212-226-9339
Practice Address - Fax:212-226-2289
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02495678Medicaid