Provider Demographics
NPI:1588159487
Name:YANG, LILLIAN (RD, CDE)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BALTIC ST APT 10B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4173
Mailing Address - Country:US
Mailing Address - Phone:614-499-6607
Mailing Address - Fax:
Practice Address - Street 1:263 7TH AVE STE 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3691
Practice Address - Country:US
Practice Address - Phone:718-246-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008361133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered