Provider Demographics
NPI:1134294424
Name:CHAN, ELIZA MAN-YEE
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:MAN-YEE
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 N LAKE DR
Mailing Address - Street 2:E
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3423
Mailing Address - Country:US
Mailing Address - Phone:925-577-3494
Mailing Address - Fax:
Practice Address - Street 1:8452 N LAKE DR
Practice Address - Street 2:E
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3423
Practice Address - Country:US
Practice Address - Phone:925-577-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered