Healthcare Provider Details

I. General information

NPI: 1023929304
Provider Name (Legal Business Name): TRUC THI KIM LE RDN, LDN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KIM LE RDN, LDN

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVE
ZION IL
60099-2676
US

IV. Provider business mailing address

400 S GREEN ST APT 209
CHICAGO IL
60607-3546
US

V. Phone/Fax

Practice location:
  • Phone: 847-342-6910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.022956
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: