Individual
MRS. ALICE THIPPHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
1290 TULLY RD STE 60, SAN JOSE, CA 95122-3069
(408) 275-0105
(408) 275-0115
Mailing address
1131 SABAL CT, SAN JOSE, CA 95132-2866
(408) 729-1247
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
R519736
IL
Other
Enumeration date
06/05/2016
Last updated
06/05/2016
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