Provider Demographics
NPI:1235897414
Name:DENG, SIYU
Entity Type:Individual
Prefix:
First Name:SIYU
Middle Name:
Last Name:DENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24315 NORTHVIEW PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1850
Mailing Address - Country:US
Mailing Address - Phone:626-866-5123
Mailing Address - Fax:
Practice Address - Street 1:1004 W FOOTHILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3791
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty