Provider Demographics
NPI:1699034611
Name:MA, SI YAN (RD)
Entity Type:Individual
Prefix:
First Name:SI YAN
Middle Name:
Last Name:MA
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 1:2489 HILLSBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1113
Mailing Address - Country:US
Mailing Address - Phone:415-867-4099
Mailing Address - Fax:
Practice Address - Street 1:2489 HILLSBOROUGH LN
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1113
Practice Address - Country:US
Practice Address - Phone:415-867-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1021089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered