Provider Demographics
NPI:1275800518
Name:LIAN, BRYAN X (RD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:X
Last Name:LIAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CRANE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4257
Mailing Address - Country:US
Mailing Address - Phone:650-308-8226
Mailing Address - Fax:
Practice Address - Street 1:1225 CRANE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4257
Practice Address - Country:US
Practice Address - Phone:650-308-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric