Healthcare Provider Details

I. General information

NPI: 1336599836
Provider Name (Legal Business Name): SHU-HUI DAI R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20718 GOLDEN RAIN RD
RIVERSIDE CA
92508-3161
US

IV. Provider business mailing address

20718 GOLDEN RAIN RD
RIVERSIDE CA
92508-3161
US

V. Phone/Fax

Practice location:
  • Phone: 951-907-5777
  • Fax:
Mailing address:
  • Phone: 951-907-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number819892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: