Provider Demographics
NPI:1487372728
Name:KWAN, LILY S (MBA, MS,RD, LD, LMNT)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:S
Last Name:KWAN
Suffix:
Gender:F
Credentials:MBA, MS,RD, LD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 TEGNER DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-5750
Mailing Address - Country:US
Mailing Address - Phone:626-590-4537
Mailing Address - Fax:
Practice Address - Street 1:904 TEGNER DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-5750
Practice Address - Country:US
Practice Address - Phone:626-590-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892681133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered