Provider Demographics
NPI:1164995833
Name:DANG, TIFFANY (RDN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 GEARY BLVD OFC 164
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3212
Mailing Address - Country:US
Mailing Address - Phone:415-379-2607
Mailing Address - Fax:415-447-1250
Practice Address - Street 1:3575 GEARY BLVD OFC 164
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3212
Practice Address - Country:US
Practice Address - Phone:415-379-2607
Practice Address - Fax:415-447-1250
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered