KG Healthy Lifestyles, Inc

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

KG HEALTHY LIFESTYLES, INC

Doing business as

Profile by Sanford

Practice address

2100 Dallas Pkwy Ste 115
Plano, TX 75093-4305

Phone

(469) 409-0156

NPI assigned

Jan 8, 2020

Organization subpart

No

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

Authorized official

Name

Kandi Suzanne Alyousef

Title

Owner

Phone

(972) 213-6201

Specialties & licenses 4

Addresses

Other names 1

• Profile by Sanford Doing business as

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1922648930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 DALLAS PKWY STE 115",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934305",
            "telephone_number": "469-409-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 DALLAS PKWY STE 115",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934305",
            "telephone_number": "469-409-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KG HEALTHY LIFESTYLES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "ALYOUSEF",
        "authorized_official_first_name": "KANDI",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-213-6201"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1501X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Profile by Sanford",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Profile by Sanford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.

Verify at the official NPI Registry.