Provider Demographics
NPI:1720415698
Name:AUYOUNG, SIU KELVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIU KELVIN
Middle Name:
Last Name:AUYOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 NINTH STREET
Mailing Address - Street 2:#206
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-836-0888
Mailing Address - Fax:510-836-0889
Practice Address - Street 1:388 NINTH STREET
Practice Address - Street 2:#206
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-836-0888
Practice Address - Fax:510-836-0889
Is Sole Proprietor?:No
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA514808Medicare PIN