Provider Demographics
NPI:1598095853
Name:HWANG, HAESUN (MS RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:HAESUN
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 CHARTRES WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0980
Mailing Address - Country:US
Mailing Address - Phone:571-274-1034
Mailing Address - Fax:
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3576
Practice Address - Country:US
Practice Address - Phone:571-295-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
723491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered