Provider Demographics
NPI:1124855622
Name:SIV, ERIC WAI KIET
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WAI KIET
Last Name:SIV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7446 SHALLOWFORD RD STE 114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2352
Mailing Address - Country:US
Mailing Address - Phone:855-871-0841
Mailing Address - Fax:
Practice Address - Street 1:7446 SHALLOWFORD RD STE 114
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2352
Practice Address - Country:US
Practice Address - Phone:855-871-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant