Provider Demographics
NPI:1700961919
Name:SIU, KATHLEEN ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:SIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:23838 WEST VALENCIA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-259-2960
Mailing Address - Fax:661-259-5983
Practice Address - Street 1:23838 WEST VALENCIA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-259-2960
Practice Address - Fax:661-259-5983
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA294721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry