NPIMap

Organization Active NPI

Dandelion Nutrition LLC

  • Registered Dietitian
  • Lacey, WA
National Provider Identifier
1285046292
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DI60202010 Issued in WA
Legal business name
DANDELION NUTRITION LLC
Practice address
4405 7TH Ave SE, Suite 200
PMB 1962
Lacey, WA 98503
Phone
(206) 799-7010
Fax
(206) 866-0204
NPI assigned
May 25, 2014
Organization subpart
Yes
Parent organization
NABI HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Authorized official

Name
Sung Hyun Mo
Title
Ceo
Phone
(201) 790-6643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X DI60202010 WA Primary

Addresses

Primary practice location

4405 7TH Ave SE, Suite 200
PMB 1962
Lacey, WA 98503

Mailing address

4405 7TH Ave SE, Suite 200
PMB 1962
Lacey, WA 98503
Phone (206) 799-7010

Other practice location 1

4400 NE 77th Ave Ste 275
Vancouver, WA 98662-6857
Phone (206) 799-7010

Other practice location 2

2900 NW Clearwater Dr Ste 200
Bend, OR 97703-9412
Phone (206) 799-7010

Other names 4

  • Dandelion Nutrition Doing business as
  • Nabi Doing business as
  • Nabi Health Doing business as
  • Dandelion Nutrition PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150417001153 WA Part B Supplier - Clinic/Group Practice 3779801998 Receives reassigned benefits from 21 practitioners
Practice locations: Seattle, WA; Vancouver, WA

National Provider Directory

National Provider Directory

Locations

7220 Linden Ave N
Seattle, WA 98103
Phone (206) 799-7010

4400 NE 77th Ave
Vancouver, WA 98662
Phone (503) 765-6335

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1400976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1285046292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 7TH AVE SE, SUITE 200",
            "address_2": "PMB 1962",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "98503",
            "telephone_number": "206-799-7010",
            "fax_number": "206-866-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 7TH AVE SE, SUITE 200",
            "address_2": "PMB 1962",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "98503",
            "telephone_number": "206-799-7010",
            "fax_number": "206-866-0204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 NE 77th Ave Ste 275",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986626857",
            "country_code": "US",
            "telephone_number": "206-799-7010",
            "fax_number": "206-866-0204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2900 NW Clearwater Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977039412",
            "country_code": "US",
            "telephone_number": "206-799-7010",
            "fax_number": "206-866-0204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DANDELION NUTRITION LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NABI HEALTH, INC.",
        "enumeration_date": "2014-05-25",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "MO",
        "authorized_official_first_name": "SUNG HYUN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "201-790-6643"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60202010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dandelion Nutrition",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nabi",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nabi Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dandelion Nutrition PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.