Provider Demographics
NPI:1922098110
Name:HSIEH, JACK MING ZU (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MING ZU
Last Name:HSIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MING ZU
Other - Middle Name:JACK
Other - Last Name:HSIEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-599-8887
Mailing Address - Fax:808-599-8879
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-599-8887
Practice Address - Fax:808-599-8879
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49346102Medicaid
HI49346101Medicaid
HI49346102Medicaid
HI55384Medicare ID - Type UnspecifiedGROUP NO.
HI49346101Medicaid