Active NPI
Susan R Wang, RD
- Registered Dietitian
- Seattle, WA
National Provider Identifier
1710041660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ID00000585
- Practice address
- 910 Boylston Ave
Seattle, WA 98104-1313 - Phone
- (206) 215-2440
- Fax
- (206) 215-2457
- NPI assigned
- Dec 21, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ID00000585 | WA | Primary |
Addresses
Primary practice location
910 Boylston Ave
Seattle, WA 98104-1313
Mailing address
PO Box 84026
Seattle, WA 98124-8426
Phone (206) 320-4476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8430050 | Medicaid | WA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ID00000585 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234915200000",
"number": "1710041660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 84026",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981248426",
"telephone_number": "206-320-4476",
"fax_number": "206-568-7043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 BOYLSTON AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041313",
"telephone_number": "206-215-2440",
"fax_number": "206-215-2457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "SUSAN",
"middle_name": "R",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-21",
"last_updated": "2009-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "ID00000585",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8430050",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.