Healthcare Provider Details

I. General information

NPI: 1629229653
Provider Name (Legal Business Name): JEE-IN MAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 LONGFELLOW DR
FREMONT CA
94539-6310
US

IV. Provider business mailing address

PO BOX 3354
FREMONT CA
94539-0335
US

V. Phone/Fax

Practice location:
  • Phone: 510-557-3710
  • Fax: 510-657-7842
Mailing address:
  • Phone: 510-557-3710
  • Fax: 510-657-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number710410
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number710410
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number710410
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number710410
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: