Healthcare Provider Details

I. General information

NPI: 1093577181
Provider Name (Legal Business Name): JUHA NAM MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 UNION ST
FLUSHING NY
11354-3050
US

IV. Provider business mailing address

2959 NORTHERN BLVD APT 32C
LONG ISLAND CITY NY
11101-3664
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-0753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: