Healthcare Provider Details

I. General information

NPI: 1568635076
Provider Name (Legal Business Name): KA-YAN MANDY CHAN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE SAINT FRANCIS HOSPITAL, NUTRITION DEPARTMENT
TULSA OK
74136-1902
US

IV. Provider business mailing address

6161 S YALE AVE SAINT FRANCIS HOSPITAL, NUTRITION DEPARTMENT
TULSA OK
74136-1902
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-7203
  • Fax: 918-494-7270
Mailing address:
  • Phone: 918-494-7203
  • Fax: 918-494-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1564
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: