Healthcare Provider Details

I. General information

NPI: 1164917282
Provider Name (Legal Business Name): BAMBOO NUTRITION THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13033 PENN ST STE 600
WHITTIER CA
90602-1682
US

IV. Provider business mailing address

PO BOX 78924
LOS ANGELES CA
90016-0924
US

V. Phone/Fax

Practice location:
  • Phone: 323-391-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DILEI YU
Title or Position: CEO
Credential:
Phone: 213-280-6375