Healthcare Provider Details

I. General information

NPI: 1720772130
Provider Name (Legal Business Name): KATHRYN JIN SIU AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON AVE FL 3
HAMDEN CT
06518-3267
US

IV. Provider business mailing address

9 WASHINGTON AVE FL 3
HAMDEN CT
06518-3267
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-8409
  • Fax: 203-281-2905
Mailing address:
  • Phone: 203-248-8409
  • Fax: 203-281-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD100051
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000758
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: