Provider Demographics
NPI:1902191836
Name:CHIN-LAI, PAM SUSAN (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:SUSAN
Last Name:CHIN-LAI
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:SUSAN
Other - Last Name:JARBOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:17300 PRESTON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4623
Mailing Address - Country:US
Mailing Address - Phone:972-930-0766
Mailing Address - Fax:
Practice Address - Street 1:17300 PRESTON RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4623
Practice Address - Country:US
Practice Address - Phone:972-930-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO 3252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered