MEDICARE: MS. DIANE K ENG RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	800232	CA

General Provider Information

NPI Number	:	1790887552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE K ENG RD

Provider Business Mailing Address
First Line	:	2374 14TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2517
Country	:	US
Telephone Number	:	415-564-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2374 14TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2517
Country	:	US
Telephone Number	:	415-564-9747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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