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General NPI Number Information
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NPI Number | 1922648930
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Entity Type | Organization
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Legal Business Name | KG HEALTHY LIFESTYLES, INC
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 2100 DALLAS PKWY STE 115
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City | PLANO
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State | TX
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Zip | 75093-4305
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Country | US
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Telephone | 469-409-0156
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 DALLAS PKWY STE 115
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City | PLANO
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State | TX
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Zip | 75093-4305
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Country | US
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Telephone | 469-409-0156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KANDI SUZANNE ALYOUSEF
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Credential |
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Telephone | 972-213-6201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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