Provider Demographics
NPI:1639141005
Name:HSIEH, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HSIEH
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 1:2101 FOREST AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1448
Mailing Address - Country:US
Mailing Address - Phone:408-295-8628
Mailing Address - Fax:408-295-8061
Practice Address - Street 1:2101 FOREST AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1448
Practice Address - Country:US
Practice Address - Phone:408-295-8628
Practice Address - Fax:408-295-8061
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75002207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00249662OtherMEDICARE RAILROAD CARRIER
CA00A750022Medicare ID - Type UnspecifiedMEDICARE PPIN
CAP00249662OtherMEDICARE RAILROAD CARRIER