Provider Demographics
NPI:1922568609
Name:HO, DAVE SIU KWAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:SIU KWAN
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3214
Mailing Address - Country:US
Mailing Address - Phone:714-456-3420
Mailing Address - Fax:714-456-8805
Practice Address - Street 1:200 S MANCHESTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3214
Practice Address - Country:US
Practice Address - Phone:714-456-3420
Practice Address - Fax:714-456-8805
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2802292084N0400X
CAA1836382084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology