Provider Demographics
NPI:1528123247
Name:SIU, MICHAEL HING-WAH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HING-WAH
Last Name:SIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:380 W PORTAL AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1428
Mailing Address - Country:US
Mailing Address - Phone:415-753-1110
Mailing Address - Fax:415-753-1123
Practice Address - Street 1:380 W PORTAL AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1428
Practice Address - Country:US
Practice Address - Phone:415-753-1110
Practice Address - Fax:415-753-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA040514OtherLICENCE #
CAAS2438249OtherDEA
CAF24805Medicare UPIN