Provider Demographics
NPI:1962038216
Name:NGUYEN, LILLIE LUU (LDN, CNS)
Entity type:Individual
Prefix:
First Name:LILLIE
Middle Name:LUU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2153
Mailing Address - Country:US
Mailing Address - Phone:818-331-7271
Mailing Address - Fax:
Practice Address - Street 1:2201 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1820
Practice Address - Country:US
Practice Address - Phone:818-293-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4748133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist