Provider Demographics
NPI:1255633277
Name:HAESUN HWANG NUTRITION CONSULTING LLC
Entity type:Organization
Organization Name:HAESUN HWANG NUTRITION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAESUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MSRDCDE
Authorized Official - Phone:571-274-1034
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:703-774-3923
Practice Address - Street 1:6300 STEVENSON AVE STE D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3554
Practice Address - Country:US
Practice Address - Phone:571-274-1034
Practice Address - Fax:703-774-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS345186-3261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service