Mimi Chan, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT83652 Issued in TX

Legal business name

MIMI CHAN, LLC

Practice address

515A South Fry Road
Suite #165
Katy, TX 77450

Phone

(832) 916-2698

NPI assigned

Jul 10, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Mimi Chan, RD, LD, CNSC, CDE

Title

Ceo

Phone

(832) 916-2698

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Nutrition Comfort, LLC Doing business as

Locations

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1194080606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515A SOUTH FRY ROAD",
            "address_2": "SUITE 165",
            "city": "KATY",
            "state": "TX",
            "postal_code": "77450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515A SOUTH FRY ROAD",
            "address_2": "SUITE #165",
            "city": "KATY",
            "state": "TX",
            "postal_code": "77450",
            "telephone_number": "832-916-2698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMI CHAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "MIMI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "832-916-2698",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RD, LD, CNSC, CDE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT83652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6236760",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9050926",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nutrition Comfort, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Registered Dietitian in Katy, TX
• Providers in Katy, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.