Provider Demographics
NPI:1164507869
Name:HSIAO, RAY (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:HSIAO
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 1:1850 S AZUSA AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6813
Mailing Address - Country:US
Mailing Address - Phone:626-854-7866
Mailing Address - Fax:626-820-0666
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-854-7866
Practice Address - Fax:626-820-0666
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G705711Medicaid
CAF11552Medicare UPIN
CA00G705711Medicaid