Healthcare Provider Details

I. General information

NPI: 1033442124
Provider Name (Legal Business Name): CHIH-CHII AMY SHIAU R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4563 BORINA DR
SAN JOSE CA
95129-2225
US

IV. Provider business mailing address

4563 BORINA DR
SAN JOSE CA
95129-2225
US

V. Phone/Fax

Practice location:
  • Phone: 408-656-5906
  • Fax: 408-517-5785
Mailing address:
  • Phone: 408-656-5906
  • Fax: 408-517-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number724244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: