1922098110 NPI number — DR. JACK MING ZU HSIEH M.D.

Table of content: DR. JACK MING ZU HSIEH M.D. (NPI 1922098110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922098110 NPI number — DR. JACK MING ZU HSIEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HSIEH
Provider First Name:
JACK
Provider Middle Name:
MING ZU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HSIEH
Provider Other First Name:
MING ZU
Provider Other Middle Name:
JACK
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922098110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N KUAKINI ST
Provider Second Line Business Mailing Address:
SUITE 607
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-599-8887
Provider Business Mailing Address Fax Number:
808-599-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N KUAKINI ST
Provider Second Line Business Practice Location Address:
SUITE 607
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-599-8887
Provider Business Practice Location Address Fax Number:
808-599-8879
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  10608 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49346102 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49346101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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