Healthcare Provider Details

I. General information

NPI: 1801635206
Provider Name (Legal Business Name): SIO CHONG DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HUNTINGTON DR
DUARTE CA
91010-2635
US

IV. Provider business mailing address

1801 HUNTINGTON DR
DUARTE CA
91010-2635
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC15133
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT142916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: