Provider Demographics
NPI:1649465162
Name:MOY, SI-YUEN (MD)
Entity type:Individual
Prefix:DR
First Name:SI-YUEN
Middle Name:
Last Name:MOY
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 1:2501 WEST 22ND STREET
Mailing Address - Street 2:111-ONC
Mailing Address - City:SIUOX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117
Mailing Address - Country:US
Mailing Address - Phone:605-336-3230
Mailing Address - Fax:605-333-5380
Practice Address - Street 1:2501 WEST 22ND STREET
Practice Address - Street 2:111-ONC
Practice Address - City:SIUOX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:605-333-5380
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234766207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03231550Medicaid