Basic Information
Provider Information | |||||||||
NPI: | 1518162072 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HSU | ||||||||
FirstName: | CHIA CHUN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HSU | ||||||||
OtherFirstName: | KELVIN | ||||||||
OtherMiddleName: | CHIA CHUN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 550 GAGE BLVD STE 101 | ||||||||
Address2: |   | ||||||||
City: | RICHLAND | ||||||||
State: | WA | ||||||||
PostalCode: | 993529532 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099423627 | ||||||||
FaxNumber: | 5096272983 | ||||||||
Practice Location | |||||||||
Address1: | 888 SWIFT BLVD | ||||||||
Address2: |   | ||||||||
City: | RICHLAND | ||||||||
State: | WA | ||||||||
PostalCode: | 99352 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099464611 | ||||||||
FaxNumber: | 5099422185 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2007 | ||||||||
LastUpdateDate: | 05/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD60549189 | WA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | 11135 | ND | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 11135 | ND | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207RN0300X | MD60549189 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 1518162072 | 05 | WA |   | MEDICAID | P00767213 | 01 | ND | RR MEDICARE | OTHER |