Individual provider Active NPI

Mon-San Wang, RDN, LDN, LD

  • Registered Dietitian
  • Austin, TX
National Provider Identifier
1144078189
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DT90116 Issued in TX
Practice address
3724 Jefferson St Ste 104
Austin, TX 78731-6204
Phone
(512) 692-7045
NPI assigned
May 6, 2024
Last updated
May 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X L005706 NC
Registered Dietitian 133V00000X DT90116 TX Primary

Addresses

Primary practice location

3724 Jefferson St Ste 104
Austin, TX 78731-6204

Mailing address

3724 Jefferson St Ste 104
Austin, TX 78731-6204
Phone (512) 692-7045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240605000529 TX Practitioner - Registered Dietitian Or Nutrition Professional 2567904600 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L005706NCMDRegistered Dietitian
DT90116TXMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Nourish, Inc. Dietitian, Registered CurrentSince May 1, 2024 Accepting new patients

Locations

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

515 S Flower St
#1015
Los Angeles, CA 90071

525 N Tryon St
Ste 1600
Charlotte, NC 28202
Phone (855) 478-8208

500 Westover Dr
Sanford, NC 27330
Phone (478) 766-4000

10260 SW Greenburg Rd
Fl 4
Tigard, OR 97223
Phone (503) 405-9338

3724 Jefferson St
Ste 104
Austin, TX 78731
Phone (512) 399-9039

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1144078189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3724 JEFFERSON ST STE 104",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787316204",
            "telephone_number": "512-692-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3724 JEFFERSON ST STE 104",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787316204",
            "telephone_number": "512-692-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "MON-SAN",
        "credential": "RDN, LDN, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L005706",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT90116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.