Individual
KYAUNA SIU-SHU SOUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, ATC
Contact information
Practice address
3351 INLAND EMPIRE BLVD APT 17G, ONTARIO, CA 91764-4863
(425) 241-7281
Mailing address
13110 NE 177TH PL # 433, WOODINVILLE, WA 98072-5740
(425) 241-7281
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/21/2020
Last updated
05/16/2023
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