Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 16922 | MD |
N | 1223P0700X | Prosthodontist | 16922 | MD |
NPI | 1245857895 |
---|---|
Provider Name | Michael Ren-Jieh Hsu |
First Address | Ellicott City, MD 21043-7962 |
Second Address | Eldersburg, MD 21784-6620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 09/07/2020 |