Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | G32104 | CA |
NPI | 1164515003 |
---|---|
Provider Name | Victor Siew |
First Address | Laguna Beach, CA 92651-1042 |
Second Address | Fountain Valley, CA 92708-4272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45009 | (02) | CA |
G32104 | (05) | CA |