Provider Demographics
NPI:1427349455
Name:GEORGE K.F.SIU MD INC.
Entity type:Organization
Organization Name:GEORGE K.F.SIU MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KF
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-435-1903
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:93710-8604
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:93710-8604
Practice Address - Country:US
Practice Address - Phone:559-435-1903
Practice Address - Fax:559-435-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG270802084N0400X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G270800OtherLICENCE # CA
CA00G270800OtherMEDICARE PTAN
CAA43209Medicare UPIN