Provider Demographics
NPI:1568579019
Name:SIU, CLARE C (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:C
Last Name:SIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3004
Mailing Address - Country:US
Mailing Address - Phone:415-876-2748
Mailing Address - Fax:415-876-2707
Practice Address - Street 1:4322 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3004
Practice Address - Country:US
Practice Address - Phone:415-876-2748
Practice Address - Fax:415-876-2707
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 74223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G742230Medicaid
00G742230Medicare ID - Type Unspecified
CA00G742230Medicaid