Provider Demographics
NPI:1407044589
Name:DR. JOAN SY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR. JOAN SY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-489-7386
Mailing Address - Street 1:5430 AVENIDA DEL TREN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4900
Mailing Address - Country:US
Mailing Address - Phone:714-610-9209
Mailing Address - Fax:888-749-6344
Practice Address - Street 1:24953 PASEO DE VALENCIA STE 1A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-460-9200
Practice Address - Fax:949-470-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-14
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG34940Medicare UPIN