MEDICARE: MISS EVELYN SWEET CHING LOW RD, CSR

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	133VN1005X	Renal Nutrition Registered Dietitian	86075647	CA

General Provider Information

NPI Number	:	1912666223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EVELYN SWEET CHING LOW RD, CSR

Provider Business Mailing Address
First Line	:	1115 S ELM DR APT 307
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1174
Country	:	US
Telephone Number	:	716-748-5572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 S ELM DR APT 307
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1174
Country	:	US
Telephone Number	:	716-748-5572
Fax Number	:

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/15/2021

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