Provider Demographics
NPI:1306073457
Name:SIU, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE, L4615
Mailing Address - Street 2:VCHCA - PHYSICIAN SERVICES
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0003
Mailing Address - Country:US
Mailing Address - Phone:805-677-5181
Mailing Address - Fax:805-677-5304
Practice Address - Street 1:300 HILLMONT AVE
Practice Address - Street 2:BLDG 340, STE 401
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-648-9830
Practice Address - Fax:805-648-9833
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-23719207T00000X
390200000X
CAA154304207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCP0600324-AS445OtherCONTROLLED SUBSTANCE
DCBD7904445-AS445OtherDEA