Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A90266 | CA |
N | 111NI0900X | Internist | A90266 | CA |
Y | 207RG0100X | Gastroenterologist | A90266 | CA |
NPI | 1003865627 |
---|---|
Provider Name | Theodore Sy |
First Address | Laguna Hills, CA 92653-8232 |
Second Address | Laguna Hills, CA 92653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 07/02/2022 |