Provider Demographics
NPI:1033328679
Name:MING ZU JACK HSIEH, MD, INC
Entity type:Organization
Organization Name:MING ZU JACK HSIEH, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MZ
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-599-8887
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-599-8887
Mailing Address - Fax:808-599-8879
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-599-8887
Practice Address - Fax:808-599-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 10608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49346101Medicaid
HI49346102Medicaid
HIH00918Medicare UPIN
HI49346101Medicaid