Provider Demographics
NPI:1497257919
Name:KAE, CHIARA MARIA (RD)
Entity Type:Individual
Prefix:
First Name:CHIARA
Middle Name:MARIA
Last Name:KAE
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-0757
Mailing Address - Country:US
Mailing Address - Phone:707-477-7791
Mailing Address - Fax:
Practice Address - Street 1:6741 SEBASTOPOL AVE STE 120-140
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3839
Practice Address - Country:US
Practice Address - Phone:707-477-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86035348133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered