Provider Demographics
NPI:1790034320
Name:HSU, CRYSTAL SHENG-SHAN (DPM)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHENG-SHAN
Last Name:HSU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHENG-SHAN
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:600 NUT TREE RD STE 310
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4686
Practice Address - Country:US
Practice Address - Phone:707-359-1816
Practice Address - Fax:707-359-1845
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program