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NPI Code Detail

MEDICARE: DR. JULIA SIU NG D.D.S.

MEDICARE: DR. JULIA SIU NG D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist59671CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
159671OTHERCADENTAL LICENSE

General Provider Information

NPI Number : 1558679795
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JULIA SIU NG D.D.S.
Provider Business Mailing Address
First Line : 15550 PINEHURST PL
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-4310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10405 TIERRASANTA BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92124-2603
Country : US
Telephone Number : 858-492-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2010
Last Update Date : 09/22/2010

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