Provider Demographics
NPI:1407882004
Name:SIAN, KENTY UY (MD)
Entity Type:Individual
Prefix:
First Name:KENTY
Middle Name:UY
Last Name:SIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E ALLUVIAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3854
Mailing Address - Country:US
Mailing Address - Phone:559-797-0501
Mailing Address - Fax:559-797-0504
Practice Address - Street 1:1855 E ALLUVIAL AVE
Practice Address - Street 2:STE. 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3854
Practice Address - Country:US
Practice Address - Phone:559-797-0501
Practice Address - Fax:559-797-0504
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75906208200000X, 2086S0122X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA759060Medicaid
CAOOA759060Medicaid