MEDICARE: SAN C HSIEH MD

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	207R00000X	Internal Medicine Physician	A25709	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851388847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAN C HSIEH MD

Provider Business Mailing Address
First Line	:	3955 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3015
Country	:	US
Telephone Number	:	619-299-3654
Fax Number	:	619-299-8124

Provider Business Practice Location Address
First Line	:	3955 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3015
Country	:	US
Telephone Number	:	619-299-3654
Fax Number	:	619-299-8124

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/21/2011

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