Provider Demographics
NPI:1700477932
Name:CHAU, PAULINE (RD, CDCES)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2935
Mailing Address - Country:US
Mailing Address - Phone:650-678-2904
Mailing Address - Fax:
Practice Address - Street 1:1828 EL CAMINO REAL STE 407
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3115
Practice Address - Country:US
Practice Address - Phone:650-678-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-09-14
Deactivation Date:2021-08-02
Deactivation Code:
Reactivation Date:2021-09-14
Provider Licenses
StateLicense IDTaxonomies
CA717086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered