Provider Demographics
NPI:1205210085
Name:CHEN, LILY LIAN (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:LIAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 MAIN ST STE 204B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6504
Mailing Address - Country:US
Mailing Address - Phone:626-236-6916
Mailing Address - Fax:
Practice Address - Street 1:3609 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6542
Practice Address - Country:US
Practice Address - Phone:626-236-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered