Provider Demographics
NPI:1831642099
Name:KENTY U SIAN MD INC
Entity Type:Organization
Organization Name:KENTY U SIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-797-0501
Mailing Address - Street 1:1855 E ALLUVIAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3854
Mailing Address - Country:US
Mailing Address - Phone:559-797-0501
Mailing Address - Fax:559-797-0504
Practice Address - Street 1:1855 E ALLUVIAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3854
Practice Address - Country:US
Practice Address - Phone:559-797-0501
Practice Address - Fax:559-797-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75906208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH57503Medicare UPIN