Provider Demographics
NPI:1790901809
Name:SIU-CHAN, WANDA M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:SIU-CHAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 ASTORIA DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3007
Mailing Address - Country:US
Mailing Address - Phone:408-735-1025
Mailing Address - Fax:
Practice Address - Street 1:777 1ST ST
Practice Address - Street 2:#171
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4918
Practice Address - Country:US
Practice Address - Phone:408-847-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered