Active NPI
Kelly Siu
- Registered Nurse
- San Francisco, CA
National Provider Identifier
1902334188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 95185240
- Practice address
- 2161 Revere Ave
San Francisco, CA 94124-2027 - Phone
- (415) 632-8450
- NPI assigned
- May 31, 2017
- Reactivated
- Jan 17, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 95185240 | CA | Primary |
Addresses
Primary practice location
2161 Revere Ave
San Francisco, CA 94124-2027
Mailing address
1001 Enclave Blvd Apt 620
Edwardsville, IL 62025-7463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781654400000",
"number": "1902334188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 ENCLAVE BLVD APT 620",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620257463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2161 REVERE AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941242027",
"telephone_number": "415-632-8450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIU",
"first_name": "KELLY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-31",
"last_updated": "2026-06-17",
"certification_date": "2026-06-17",
"deactivation_date": "2023-06-10",
"reactivation_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "95185240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.