Victoria Lynn Lydeen, MS, RDN, CSR

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86017647 Issued in CA

Practice address

5594 Soria Dr
Montclair, CA 91762-7646

Phone

(818) 207-4225

Fax

(626) 625-3050

NPI assigned

Dec 20, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nourish, Inc.Group PAC ID 1557724937, 288 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Kind Kidney LLC

  • Renal Nutrition Registered Dietitian
  • Pasadena, CA
  • NPI 1740860659
  NPD
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638662400000",
    "number": "1386189892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 E COLORADO BLVD # 2501",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011903",
            "telephone_number": "818-207-4225",
            "fax_number": "626-628-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5594 SORIA DR",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917627646",
            "telephone_number": "818-207-4225",
            "fax_number": "626-625-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDEEN",
        "first_name": "VICTORIA",
        "middle_name": "LYNN",
        "credential": "MS, RDN, CSR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-20",
        "last_updated": "2021-12-05",
        "certification_date": "2021-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86017647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kindkidneyllc.com",
            "affiliation": "N",
            "endpointDescription": "Practice website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "438 N Hill Ave",
            "city": "Pasadena",
            "state": "CA",
            "country_code": "US",
            "postal_code": "911061221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kaylee Milan Luquin
• Priscilla T Luu, PHARMD
• Luxottica of America Inc.
• Luxottica of America Inc.
• Luxottica Retail North America, Inc
• M Aaron Lalezarian MD Corporation
• Christina Ma
• Aydin Macias
• Emily Macias
• Madeline Macias

• Registered Dietitian in Montclair, CA
• Providers in Montclair, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.