Healthcare Provider Details

I. General information

NPI: 1275345779
Provider Name (Legal Business Name): SIUWAI ELAINE SIU MS, RD, CNSC, CSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 02/26/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E. HUNGTINGTON DR., STE 107 #1209
ARCADIA CA
91006-8501
US

IV. Provider business mailing address

411 E. HUNGTINGTON DR., STE 107 #1209
ARCADIA CA
91006-8501
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-3848
  • Fax:
Mailing address:
  • Phone: 626-227-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number968867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: