1841594256 NPI number — VICTOR B. SIEW, M.D., INC

Table of content: (NPI 1841594256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841594256 NPI number — VICTOR B. SIEW, M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTOR B. SIEW, M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841594256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17220 NEWHOPE ST STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-4283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-435-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17220 NEWHOPE ST STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-4283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-435-0600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIEW
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-435-0600

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G32104 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G32104 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".