Healthcare Provider Details

I. General information

NPI: 1356018741
Provider Name (Legal Business Name): JULIA NGOC NGUYEN RD, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SUNNYBROOK RD STE 200
RALEIGH NC
27610-1855
US

IV. Provider business mailing address

512 BRICKHAVEN DR
RALEIGH NC
27606-6345
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number32300853
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006094
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: