Provider Demographics
NPI:1215935622
Name:HSU, LARRY C (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COHASSET RD
Mailing Address - Street 2:STE 10
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2210
Mailing Address - Country:US
Mailing Address - Phone:530-893-9244
Mailing Address - Fax:530-893-1249
Practice Address - Street 1:254 COHASSET RD
Practice Address - Street 2:STE 10
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2210
Practice Address - Country:US
Practice Address - Phone:530-893-9244
Practice Address - Fax:530-893-1249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG36314Medicaid
A46644Medicare UPIN
CA00G363140Medicare ID - Type Unspecified