Provider Demographics
NPI:1386279792
Name:HEALTHY MISSION DIETITIAN, INC.
Entity type:Organization
Organization Name:HEALTHY MISSION DIETITIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSR, CLT, FAND
Authorized Official - Phone:626-873-1273
Mailing Address - Street 1:469 N CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2373
Mailing Address - Country:US
Mailing Address - Phone:626-873-1273
Mailing Address - Fax:626-231-0616
Practice Address - Street 1:50 W LEMON AVE STE 8
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5112
Practice Address - Country:US
Practice Address - Phone:626-268-1353
Practice Address - Fax:626-231-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty