Provider Demographics
NPI:1457801094
Name:LAO, SUONG D
Entity Type:Individual
Prefix:MISS
First Name:SUONG
Middle Name:D
Last Name:LAO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:LAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:1700 E 13TH ST APT 15XE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3266
Mailing Address - Country:US
Mailing Address - Phone:808-221-1712
Mailing Address - Fax:
Practice Address - Street 1:1700 E 13TH ST APT 15XE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3266
Practice Address - Country:US
Practice Address - Phone:808-221-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered