Provider Demographics
NPI:1912968389
Name:HSU, BRADFORD T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:T
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 1:1472 BRADLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6935
Mailing Address - Country:US
Mailing Address - Phone:619-578-3899
Mailing Address - Fax:
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-425-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A861790Medicaid
CAWA86179AMedicare ID - Type Unspecified
CA00A861790Medicaid