Healthcare Provider Details

I. General information

NPI: 1598127466
Provider Name (Legal Business Name): STANLEY H SIU DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST SUITE 825
SAN FRANCISCO CA
94104-3402
US

IV. Provider business mailing address

220 MONTGOMERY ST SUITE 825
SAN FRANCISCO CA
94104-3402
US

V. Phone/Fax

Practice location:
  • Phone: 415-981-9000
  • Fax: 415-981-9006
Mailing address:
  • Phone: 415-981-9000
  • Fax: 415-981-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY H SIU
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 415-312-4127