Provider Demographics
NPI:1134518988
Name:KATHLEEN A SIU PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KATHLEEN A SIU PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-259-2960
Mailing Address - Street 1:23838 VALENCIA BLVD
Mailing Address - Street 2:300
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5319
Mailing Address - Country:US
Mailing Address - Phone:661-259-2960
Mailing Address - Fax:661-259-5983
Practice Address - Street 1:23838 VALENCIA BLVD
Practice Address - Street 2:300
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5319
Practice Address - Country:US
Practice Address - Phone:661-259-2960
Practice Address - Fax:661-259-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286181223P0221X
CA294721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty