Healthcare Provider Details

I. General information

NPI: 1053914267
Provider Name (Legal Business Name): NGAN LY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 HILLENDAHL BLVD STE 101
HOUSTON TX
77055-3402
US

IV. Provider business mailing address

4820 CAROLINE ST APT 407
HOUSTON TX
77004-5673
US

V. Phone/Fax

Practice location:
  • Phone: 713-462-6565
  • Fax:
Mailing address:
  • Phone: 713-208-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: