MEDICARE: DR. JESSICA KEE HSIEH DDS, MDSC, FACP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7395	OK
2	1223P0700X	Prosthodontics	DN1857177	MA
3	1223P0700X	Prosthodontics	63030	CA
4	1223P0700X	Prosthodontics	39	OK

General Provider Information

NPI Number	:	1770923005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA KEE HSIEH DDS, MDSC, FACP

Provider Business Mailing Address
First Line	:	4101 JAMES DRIVE
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-5019
Country	:	US
Telephone Number	:	626-731-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 BROADWAY EXTENSION SUITE 150
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-2215
Country	:	US
Telephone Number	:	405-467-9470
Fax Number	:	405-467-9471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	01/09/2022

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