Healthcare Provider Details

I. General information

NPI: 1780530857
Provider Name (Legal Business Name): GGKIDNEYDIETITIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 MERCURE CIR STE 271
DULLES VA
20166-3802
US

IV. Provider business mailing address

40802 MARTINA CT
ALDIE VA
20105-4138
US

V. Phone/Fax

Practice location:
  • Phone: 571-293-1087
  • Fax: 703-263-8040
Mailing address:
  • Phone: 571-293-1087
  • Fax: 703-263-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GIRIJA VIJAYKUMAR
Title or Position: OWNER / DIETITIAN
Credential: RD
Phone: 571-293-1087