MEDICARE: DR. STANLEY SIU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	56679	CA

General Provider Information

NPI Number	:	1174696579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY SIU DDS

Provider Business Mailing Address
First Line	:	220 MONTGOMERY ST
Second Line	:	SUITE 825
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-3402
Country	:	US
Telephone Number	:	415-981-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 MONTGOMERY ST
Second Line	:	SUITE 825
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-3402
Country	:	US
Telephone Number	:	415-981-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/27/2016

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Directions to “ DR. STANLEY SIU DDS” Practice Location

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