Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00033906 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD00033906 | WA |
NPI | 1164401444 |
---|---|
Provider Name | Benjamin Hsu |
First Address | Spokane, WA 99218-1257 |
Second Address | Spokane, WA 99218-1257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 05/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1115013 | (05) | WA |
F08412 | (02) | WA |
KQ241 | BLUE CROSS IDAHO (01) | WA |