Provider Demographics
NPI:1841594256
Name:VICTOR B. SIEW, M.D., INC
Entity Type:Organization
Organization Name:VICTOR B. SIEW, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-435-0600
Mailing Address - Street 1:17220 NEWHOPE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4283
Mailing Address - Country:US
Mailing Address - Phone:714-435-0600
Mailing Address - Fax:
Practice Address - Street 1:17220 NEWHOPE ST STE 125
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4283
Practice Address - Country:US
Practice Address - Phone:714-435-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG32104Medicaid
CAG32104Medicaid