Healthcare Provider Details

I. General information

NPI: 1134773989
Provider Name (Legal Business Name): CARMEN KAI MAN TSE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 6
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

550 16TH ST 5TH FLOOR; BOX 0136
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2813
  • Fax:
Mailing address:
  • Phone: 415-476-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1003048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: