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General NPI Number Information
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NPI Number | 1194717512
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Entity Type | Individual
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Provider Name | JOHNNY SIA GAW I M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 931 BUENA VISTA ST SUITE #106
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City | DUARTE
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State | CA
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Zip | 91010-1712
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Country | US
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Telephone | 626-359-8929
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Fax | 626-359-2280
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Provider Business Mailing Address
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Address Line | 931 BUENA VISTA ST SUITE #106
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City | DUARTE
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State | CA
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Zip | 91010-1712
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Country | US
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Telephone | 626-359-8929
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Fax | 626-359-2280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A38464
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License Number State | CA
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