Basic Information
| Provider Information | |||||||||
| NPI: | 1265868418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HSU | ||||||||
| FirstName: | JOHANAN | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16605 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 400 MOB3 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812750800 | ||||||||
| FaxNumber: | 2812750801 | ||||||||
| Practice Location | |||||||||
| Address1: | 16605 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 400 MOB3 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812750800 | ||||||||
| FaxNumber: | 2812750801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q8511 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 368064701 | 05 | TX | MEDICAID | 8GJ458 | 01 | TX | BCBS | OTHER |