Provider Demographics
NPI:1801280953
Name:HSUEH, POWEN (DO)
Entity type:Individual
Prefix:
First Name:POWEN
Middle Name:
Last Name:HSUEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79430 HIGHWAY 111 STE 102
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4549
Mailing Address - Country:US
Mailing Address - Phone:951-827-7793
Mailing Address - Fax:
Practice Address - Street 1:79430 HIGHWAY 111 STE 102
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4549
Practice Address - Country:US
Practice Address - Phone:951-827-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34016727208000000X, 208M00000X
NE1614208D00000X
CA20A18688208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0022352Medicaid