Provider Demographics
NPI:1710955364
Name:SIU, ALBERT KQ (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:KQ
Last Name:SIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2625 COFFEE RD
Mailing Address - Street 2:STE S
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2050
Mailing Address - Country:US
Mailing Address - Phone:209-577-1200
Mailing Address - Fax:209-577-6517
Practice Address - Street 1:2625 COFFEE RD
Practice Address - Street 2:STE S
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2050
Practice Address - Country:US
Practice Address - Phone:209-577-1200
Practice Address - Fax:209-577-6517
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42209207ZP0102X, 207ZC0500X, 207ZD0900X, 207ZH0000X, 207ZI0100X, 207ZP0105X, 207ZP0213X, 207ZB0001X, 207ZP0104X, 207ZM0300X, 207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA220020692OtherRAILROAD MEDICARE NO
CABO964OtherMEDICARE PTAN
CALAB09388FMedicaid
CALAB09388FMedicaid