Provider Demographics
NPI:1568635076
Name:CHAN, KA-YAN MANDY (RD, LD)
Entity type:Individual
Prefix:
First Name:KA-YAN MANDY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 S YALE AVE
Mailing Address - Street 2:SAINT FRANCIS HOSPITAL, NUTRITION DEPARTMENT
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1902
Mailing Address - Country:US
Mailing Address - Phone:918-494-7203
Mailing Address - Fax:918-494-7270
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:SAINT FRANCIS HOSPITAL, NUTRITION DEPARTMENT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-7203
Practice Address - Fax:918-494-7270
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered