Provider Demographics
NPI:1720591571
Name:YANG, ALICIA DAN (MPH, RDN, CD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:DAN
Last Name:YANG
Suffix:
Gender:F
Credentials:MPH, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 17TH AVE E UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5214
Mailing Address - Country:US
Mailing Address - Phone:714-488-6459
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6947
Practice Address - Country:US
Practice Address - Phone:206-415-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60803102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered