Provider Demographics
NPI:1598197402
Name:YANG, EDITH (RD, CSR, CLT, FAND)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:RD, CSR, CLT, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 N CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2373
Mailing Address - Country:US
Mailing Address - Phone:626-873-1273
Mailing Address - Fax:626-231-0616
Practice Address - Street 1:50 W LEMON AVE STE 8
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5112
Practice Address - Country:US
Practice Address - Phone:626-873-1273
Practice Address - Fax:626-231-0616
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133VN1005X
CA86011113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal