Provider Demographics
NPI:1851643563
Name:LEE, KATRIN KALO (RD, CDN)
Entity Type:Individual
Prefix:
First Name:KATRIN
Middle Name:KALO
Last Name:LEE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:KALO
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:22 N 6TH ST
Mailing Address - Street 2:20I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3075
Mailing Address - Country:US
Mailing Address - Phone:646-262-5445
Mailing Address - Fax:
Practice Address - Street 1:22 N 6TH ST
Practice Address - Street 2:20I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3075
Practice Address - Country:US
Practice Address - Phone:646-262-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1034217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered