Provider Demographics
NPI:1932318425
Name:FAN-HSU, JUDY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:FAN-HSU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SUPERIOR ST
Mailing Address - Street 2:UNIT 1704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8132
Mailing Address - Country:US
Mailing Address - Phone:240-888-7924
Mailing Address - Fax:
Practice Address - Street 1:500 W SUPERIOR ST
Practice Address - Street 2:UNIT 1704
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8132
Practice Address - Country:US
Practice Address - Phone:240-888-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.029661OtherILLINOIS DENTAL LICENSE
MD13827OtherMARYLAND DENTAL LICENSE