Healthcare Provider Details

I. General information

NPI: 1922098110
Provider Name (Legal Business Name): JACK MING ZU HSIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MING ZU JACK HSIEH M.D.

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST SUITE 607
HONOLULU HI
96817-6300
US

IV. Provider business mailing address

405 N KUAKINI ST SUITE 607
HONOLULU HI
96817-6300
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-8887
  • Fax: 808-599-8879
Mailing address:
  • Phone: 808-599-8887
  • Fax: 808-599-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10608
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: