Healthcare Provider Details

I. General information

NPI: 1457913576
Provider Name (Legal Business Name): JERRY HSIEH, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18255 BROOKHURST ST STE 100
FOUNTAIN VALLEY CA
92708-6771
US

IV. Provider business mailing address

18255 BROOKHURST ST STE 100
FOUNTAIN VALLEY CA
92708-6771
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-6135
  • Fax: 949-416-5861
Mailing address:
  • Phone: 949-424-6135
  • Fax: 949-416-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY N HSIEH
Title or Position: CEO
Credential: MD
Phone: 949-424-6135