Provider Demographics
NPI:1386084036
Name:HSU, KEAN (PHD)
Entity type:Individual
Prefix:PROF
First Name:KEAN
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N RANDOLPH ST APT 505
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2178
Mailing Address - Country:US
Mailing Address - Phone:203-435-0870
Mailing Address - Fax:
Practice Address - Street 1:2115 WISCONSIN AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2265
Practice Address - Country:US
Practice Address - Phone:203-435-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38037103T00000X, 103TC0700X
DC1001617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical