Healthcare Provider Details

I. General information

NPI: 1689369332
Provider Name (Legal Business Name): JOSHUA SIU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRADUATE MEDICAL EDUCATION OFFICE LOMA LINDA UNIVERSITY 11234 ANDERSON ST STE 202
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11234 ANDERSON ST STE 202
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A25204
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3967
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: