Healthcare Provider Details

I. General information

NPI: 1205758182
Provider Name (Legal Business Name): JOYLEEN KOGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-3837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN4269
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: