MEDICARE: KEL-ANN HSIEH AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	NP95016834	CA

General Provider Information

NPI Number	:	1679224786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEL-ANN HSIEH AGPCNP-BC

Provider Business Mailing Address
First Line	:	4315 W 182ND ST UNIT 326
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-4526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 HERMOSA AVE
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3532
Country	:	US
Telephone Number	:	424-262-7000
Fax Number	:

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

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	01/11/2022

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