Provider Demographics
NPI:1598055709
Name:HSIEH, JERRY NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:NICHOLAS
Last Name:HSIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9900 TALBERT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:949-424-6135
Mailing Address - Fax:949-416-5861
Practice Address - Street 1:9900 TALBERT AVE STE 100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:949-424-6135
Practice Address - Fax:949-416-5861
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150260207R00000X, 207RC0200X, 207RP1001X, 207RP1001X, 207RC0200X
PAMT199954207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease