Provider Demographics
NPI:1457561037
Name:CHU, MOONYOUNG
Entity Type:Individual
Prefix:MRS
First Name:MOONYOUNG
Middle Name:
Last Name:CHU
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 1:19951 24TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4129
Mailing Address - Country:US
Mailing Address - Phone:718-352-7567
Mailing Address - Fax:718-352-7567
Practice Address - Street 1:19951 24TH RD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4129
Practice Address - Country:US
Practice Address - Phone:718-352-7567
Practice Address - Fax:718-352-7567
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000808-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered