Provider Demographics
NPI:1619009255
Name:HWANG, JEEAE SOPHIE (RD)
Entity Type:Individual
Prefix:MS
First Name:JEEAE
Middle Name:SOPHIE
Last Name:HWANG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JEE AE
Other - Middle Name:
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2500 MERCED STREET
Mailing Address - Street 2:NUTRITION SERVICES DEPARTMENT
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-454-3438
Mailing Address - Fax:510-752-6550
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric