Active NPI
Suren Jenny Chiu, LDN
- Registered Dietitian
- Decatur, IL
National Provider Identifier
1275006074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.007568
- Practice address
- 4775 E Maryland St
Decatur, IL 62521-8802 - Phone
- (217) 876-3737
- Fax
- (217) 876-3468
- NPI assigned
- Jan 4, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.007568 | IL | Primary |
| Nutritionist | 133N00000X | 164.007568 | IL |
Addresses
Primary practice location
4775 E Maryland St
Decatur, IL 62521-8802
Mailing address
4775 E Maryland St
Decatur, IL 62521-8802
Phone (217) 864-3737
Other names 1
- Suren Kanchanavaleerat
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.007568 | IL | MD | Nutritionist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suren Chiu Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579132800000",
"number": "1275006074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4775 E MARYLAND ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625218802",
"telephone_number": "217-864-3737",
"fax_number": "217-864-3468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4775 E MARYLAND ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625218802",
"telephone_number": "217-876-3737",
"fax_number": "217-876-3468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHIU",
"first_name": "SUREN",
"middle_name": "JENNY",
"credential": "LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-04",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.007568",
"primary": true
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": "164.007568",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUREN",
"last_name": "KANCHANAVALEERAT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.