Healthcare Provider Details

I. General information

NPI: 1609817733
Provider Name (Legal Business Name): S. JUDY HSIEH PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 JOHNSON AVE
CUPERTINO CA
95014-3815
US

IV. Provider business mailing address

3304 ALPINE LILY DR
LAS VEGAS NV
89141-3249
US

V. Phone/Fax

Practice location:
  • Phone: 702-514-6911
  • Fax: 702-710-1788
Mailing address:
  • Phone: 702-514-6911
  • Fax: 702-710-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY13477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: