Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD168402 | OR |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD168402 | OR |
NPI | 1275854671 |
---|---|
Provider Name | Wai Man Belinda Siu |
First Address | Portland, OR 97225 |
Second Address | Portland, OR 97225-2215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2010 |
Last Update Date | 17/03/2018 |