Provider Demographics
NPI:1851388847
Name:HSIEH, SAN C (MD)
Entity Type:Individual
Prefix:
First Name:SAN
Middle Name:C
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 1:3955 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3015
Mailing Address - Country:US
Mailing Address - Phone:619-299-3654
Mailing Address - Fax:619-299-8124
Practice Address - Street 1:3955 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3015
Practice Address - Country:US
Practice Address - Phone:619-299-3654
Practice Address - Fax:619-299-8124
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25709Medicaid
B50017Medicare UPIN
CAA25709Medicaid