MEDICARE: DR. JOHN SIU D.M.D.

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	28321	TX

General Provider Information

NPI Number	:	1386956514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SIU D.M.D.

Provider Business Mailing Address
First Line	:	1530 W GRAND PKWY S
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-8257
Country	:	US
Telephone Number	:	281-769-7648
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 W GRAND PKWY S
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-8257
Country	:	US
Telephone Number	:	281-769-7648
Fax Number	:

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	12/13/2020

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Directions to “ DR. JOHN SIU D.M.D.” Practice Location

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