Provider Demographics
NPI:1902171473
Name:LEI, CHIO TENG (MPH, RD, CNSC)
Entity Type:Individual
Prefix:
First Name:CHIO TENG
Middle Name:
Last Name:LEI
Suffix:
Gender:F
Credentials:MPH, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 CARICO WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6387
Mailing Address - Country:US
Mailing Address - Phone:415-971-8739
Mailing Address - Fax:
Practice Address - Street 1:1045 N EL DORADO ST STE 4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1323
Practice Address - Country:US
Practice Address - Phone:209-227-0722
Practice Address - Fax:866-862-8832
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007126-1133V00000X
1029206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered