Healthcare Provider Details

I. General information

NPI: 1235403379
Provider Name (Legal Business Name): CAROL CHUANG MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 4TH ST 219
SAN FRANCISCO CA
94107-1618
US

IV. Provider business mailing address

660 4TH ST 219
SAN FRANCISCO CA
94107-1618
US

V. Phone/Fax

Practice location:
  • Phone: 415-652-9942
  • Fax:
Mailing address:
  • Phone: 415-652-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: