Provider Demographics
NPI:1770923005
Name:HSIEH, JESSICA KEE (DDS, MDSC, FACP)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KEE
Last Name:HSIEH
Suffix:
Gender:F
Credentials:DDS, MDSC, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 JAMES DRIVE
Mailing Address - Street 2:
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145-5019
Mailing Address - Country:US
Mailing Address - Phone:626-731-9838
Mailing Address - Fax:
Practice Address - Street 1:9400 BROADWAY EXTENSION SUITE 150
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2215
Practice Address - Country:US
Practice Address - Phone:405-467-9470
Practice Address - Fax:405-467-9471
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73951223G0001X
MADN18571771223P0700X
CA630301223P0700X
OK391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice