MEDICARE: GGKIDNEYDIETITIAN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1780530857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GGKIDNEYDIETITIAN LLC

Provider Business Mailing Address
First Line	:	40802 MARTINA CT
Second Line	:
City	:	ALDIE
State	:	VA
Zip	:	20105-4138
Country	:	US
Telephone Number	:	571-293-1087
Fax Number	:	703-263-8040

Provider Business Practice Location Address
First Line	:	44330 MERCURE CIR STE 271
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20166-3802
Country	:	US
Telephone Number	:	571-293-1087
Fax Number	:	703-263-8040

Authorized Official
Title or Position	:	OWNER / DIETITIAN
Name	:	GIRIJA VIJAYKUMAR
Credential	:	RD
Telephone Number	:	571-293-1087

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	06/05/2026

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Directions to “GGKIDNEYDIETITIAN LLC ” Practice Location

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