Basic Information
| Provider Information | |||||||||
| NPI: | 1316039209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEUNG | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | YANG | ||||||||
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| Credential: | MS RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17710 PHELPS HILL LN | ||||||||
| Address2: | |||||||||
| City: | DERWOOD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208551359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 N. GREENE ST | ||||||||
| Address2: | VETERANS AFFAIRS MEDICAL CTR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 03/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 948685 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.