Provider Demographics
NPI:1083783484
Name:DR TJ SYIAU MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR TJ SYIAU MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN-JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYAIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-250-9698
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty