Provider Demographics
NPI:1285723825
Name:SIU, GEORGE KWOCK FAI (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KWOCK FAI
Last Name:SIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6181 N THESTA ST
Mailing Address - Street 2:#102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-435-1903
Mailing Address - Fax:559-435-3911
Practice Address - Street 1:6181 N THESTA ST
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-435-1903
Practice Address - Fax:559-435-3911
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG270802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43209Medicare UPIN