Provider Demographics
NPI:1366511768
Name:SYIAU, TIN-JON (MD)
Entity type:Individual
Prefix:
First Name:TIN-JON
Middle Name:
Last Name:SYIAU
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:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-1958
Mailing Address - Country:US
Mailing Address - Phone:626-821-0655
Mailing Address - Fax:626-254-9220
Practice Address - Street 1:150 N SANTA ANITA AVE STE 645
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3140
Practice Address - Country:US
Practice Address - Phone:626-821-0655
Practice Address - Fax:626-254-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64781207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A647810Medicaid
CA00A647810Medicaid
CAA064781Medicare ID - Type Unspecified