Provider Demographics
NPI:1760221519
Name:HSU, TZU YI (DMD)
Entity type:Individual
Prefix:DR
First Name:TZU YI
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CLEMENT
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:301 N WALKER AVE APT 4308
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1854
Mailing Address - Country:US
Mailing Address - Phone:857-316-5112
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK7933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program