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General NPI Number Information
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NPI Number | 1255633277
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Entity Type | Organization
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Legal Business Name | HAESUN HWANG NUTRITION CONSULTING LLC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 6300 STEVENSON AVE STE D
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3554
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Country | US
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Telephone | 571-274-1034
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Fax | 703-774-3923
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Provider Business Mailing Address
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Address Line | 11432 CHARTRES WAY
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City | FAIRFAX
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State | VA
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Zip | 22030-0980
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Country | US
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Telephone | 571-274-1034
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Fax | 703-774-3923
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HAESUN HWANG
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Credential | MS.RD.CDE.
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Telephone | 571-274-1034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | S345186-3
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License Number State | VA
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