Provider Demographics
NPI:1467479121
Name:M. JACK HSIEH, D.D.S. AND JENNY C., AU, D.D.S., INC
Entity Type:Organization
Organization Name:M. JACK HSIEH, D.D.S. AND JENNY C., AU, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN-KWEI
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-545-0061
Mailing Address - Street 1:1101 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5948
Mailing Address - Country:US
Mailing Address - Phone:310-545-0061
Mailing Address - Fax:310-545-1569
Practice Address - Street 1:1101 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5948
Practice Address - Country:US
Practice Address - Phone:310-545-0061
Practice Address - Fax:310-545-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty