Provider Demographics
NPI:1578766002
Name:DONALD SIAO, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DONALD SIAO, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-223-7771
Mailing Address - Street 1:2690 S WHITE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2076
Mailing Address - Country:US
Mailing Address - Phone:408-223-7771
Mailing Address - Fax:408-223-7779
Practice Address - Street 1:2690 S WHITE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2076
Practice Address - Country:US
Practice Address - Phone:408-223-7771
Practice Address - Fax:408-223-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77203Medicare UPIN