A 6.4-magnitude earthquake shook Taiwan's tourist city of Hualien just before midnight, leaving at least two dead, 200 injured and buildings and roads damaged.
Rescue officials are searching for the 150 missing people, most of whom are believed trapped inside buildings.
Around 40,000 households have been left without water, and 600 without electricity.
Two years ago, a quake on the same day killed 116.
Strong 6.4-magnitude quake hits Taiwan, massive damage
150 people trapped in buildings have already been rescued
The quake hit 22km northeast of the coastal city. It was felt even in capital Taipei, over 160km away.
Photos showed tilted buildings, cracked roads and scattered debris.
At least four buildings, including the 10-storey Marshal Hotel and a military hospital, had collapsed or were tilting.
About 150 people have already been pulled out of the rubble, but frequent powerful aftershocks complicated efforts.
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Taiwan prone to deadly earthquakes, 2,000 killed in 1999
Taiwan, located near the junction of two tectonic plates, is highly vulnerable to earthquakes. Tuesday's came after almost 100 smaller tremors in the last week.
Over 100 people were killed in a 2016 quake in southern Taiwan. The worst disaster in recent history was a 1999 7.6-magnitude earthquake that killed over 2,000.
Two years ago, 116 were killed in a 6.4-magnitude quake in Pingtung.