Provider Demographics
NPI:1376165563
Name:TANG, JULIE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18723 VIA PRINCESSA # 1031
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4954
Mailing Address - Country:US
Mailing Address - Phone:323-300-4981
Mailing Address - Fax:
Practice Address - Street 1:25399 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1615
Practice Address - Country:US
Practice Address - Phone:323-300-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86036469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered