MEDICARE: SABRINA IAN LOK SONG RD, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86170879

General Provider Information

NPI Number	:	1295578458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA IAN LOK SONG RD, CDN

Provider Business Mailing Address
First Line	:	4210 27TH ST APT 10E
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4178
Country	:	US
Telephone Number	:	717-891-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 27TH ST APT 10E
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4178
Country	:	US
Telephone Number	:	717-891-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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