Provider Demographics
NPI:1356005656
Name:LAU, KA (RD)
Entity Type:Individual
Prefix:
First Name:KA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CLEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2147
Mailing Address - Country:US
Mailing Address - Phone:415-867-4924
Mailing Address - Fax:
Practice Address - Street 1:710 CLEARFIELD DR
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2147
Practice Address - Country:US
Practice Address - Phone:415-867-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA993333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered