Provider Demographics
NPI:1841747086
Name:MY HAPPY WEIGHT
Entity type:Organization
Organization Name:MY HAPPY WEIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAN CHI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RD
Authorized Official - Phone:240-601-4097
Mailing Address - Street 1:14743 TAMARACK PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3135
Mailing Address - Country:US
Mailing Address - Phone:240-601-4097
Mailing Address - Fax:
Practice Address - Street 1:14743 TAMARACK PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3135
Practice Address - Country:US
Practice Address - Phone:240-601-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000639305S00000X
VA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service