Healthcare Provider Details

I. General information

NPI: 1578775334
Provider Name (Legal Business Name): NING WAN MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WELCH RD RM MS 5891
PALO ALTO CA
94304-1502
US

IV. Provider business mailing address

12 SUTTER CREEK LN
MOUNTAIN VIEW CA
94043-3109
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8214
  • Fax: 650-736-2130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number896706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: