Basic Information
Provider Information
NPI: 1891921458
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HSU
FirstName: KEITH
MiddleName: CHUNYEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26800 CROWN VALLEY PKWY STE 305
Address2:  
City: MISSION VIEJO
State: CA
PostalCode: 926918017
CountryCode: US
TelephoneNumber: 9493646000
FaxNumber:  
Practice Location
Address1: 26800 CROWN VALLEY PKWY
Address2: SUITE 305
City: MISSION VIEJO
State: CA
PostalCode: 926916384
CountryCode: US
TelephoneNumber: 9493646000
FaxNumber: 9493670518
Other Information
ProviderEnumerationDate: 06/09/2009
LastUpdateDate: 10/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA110787CCAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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