Provider Demographics
NPI:1194717512
Name:GAW, JOHNNY SIA I (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:SIA
Last Name:GAW
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:COHU
Other - Last Name:GAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:931 BUENA VISTA ST
Mailing Address - Street 2:SUITE #106
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1712
Mailing Address - Country:US
Mailing Address - Phone:626-359-8929
Mailing Address - Fax:626-359-2280
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:SUITE #106
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-359-8929
Practice Address - Fax:626-359-2280
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38464207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A384640Medicaid
CAD72106Medicare UPIN
CA00A384640Medicaid