Provider Demographics
NPI:1609817733
Name:HSIEH, S. JUDY (PHD)
Entity Type:Individual
Prefix:
First Name:S. JUDY
Middle Name:
Last Name:HSIEH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3815
Mailing Address - Country:US
Mailing Address - Phone:408-973-1253
Mailing Address - Fax:408-973-1253
Practice Address - Street 1:19925 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2300
Practice Address - Country:US
Practice Address - Phone:415-345-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL134770Medicare ID - Type Unspecified