Provider Demographics
NPI:1164108056
Name:JASON, SERENA HUI
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:HUI
Last Name:JASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 SHADY RUN TERRACE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011
Mailing Address - Country:US
Mailing Address - Phone:702-461-8823
Mailing Address - Fax:
Practice Address - Street 1:1124 SHADY RUN TERRACE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011
Practice Address - Country:US
Practice Address - Phone:702-461-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL972896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered