Provider Demographics
NPI:1477158657
Name:SIU, LAURIE CHANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:CHANG
Last Name:SIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3439
Mailing Address - Country:US
Mailing Address - Phone:626-475-4597
Mailing Address - Fax:
Practice Address - Street 1:1565 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4233
Practice Address - Country:US
Practice Address - Phone:323-529-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist