Healthcare Provider Details

I. General information

NPI: 1851949887
Provider Name (Legal Business Name): JAMIE MOK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR STE 506
LOS ANGELES CA
90008-3656
US

V. Phone/Fax

Practice location:
  • Phone: 510-386-2041
  • Fax:
Mailing address:
  • Phone: 323-617-5409
  • Fax: 323-617-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1021654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: