Provider Demographics
NPI:1689862484
Name:SIUMAN FAN DDS INC.
Entity Type:Organization
Organization Name:SIUMAN FAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-692-4310
Mailing Address - Street 1:2020 CAMINO DEL RIO N
Mailing Address - Street 2:101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1541
Mailing Address - Country:US
Mailing Address - Phone:619-692-4310
Mailing Address - Fax:
Practice Address - Street 1:2020 CAMINO DEL RIO N
Practice Address - Street 2:101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1541
Practice Address - Country:US
Practice Address - Phone:619-692-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811070295OtherTYPE 1 NPI