Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 34521 | CA |
NPI | 1053926790 |
---|---|
Provider Name | Darren Siu |
First Address | San Jose, CA 95110-3816 |
Second Address | San Jose, CA 95110-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |