Healthcare Provider Details

I. General information

NPI: 1598055709
Provider Name (Legal Business Name): JERRY NICHOLAS HSIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17305 VON KARMAN AVE STE 201
IRVINE CA
92614-6674
US

IV. Provider business mailing address

17305 VON KARMAN AVE STE 201
IRVINE CA
92614-6674
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 TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA150260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA150260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: