Basic Information
Provider Information
NPI: 1184759797
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HSU
FirstName: JAMES
MiddleName: TIEN TI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5655 HUDSON DR STE 210
Address2:  
City: HUDSON
State: OH
PostalCode: 442364455
CountryCode: US
TelephoneNumber: 3306551839
FaxNumber: 3306553828
Practice Location
Address1: 600 CAISSON HILL RD
Address2:  
City: FORT RILEY
State: KS
PostalCode: 664427037
CountryCode: US
TelephoneNumber: 7852397715
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2007
LastUpdateDate: 11/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X01062575AINN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XN7624TXY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XA115666CAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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