Provider Demographics
NPI:1740462258
Name:YOON, JENNIFER (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MCLAUGHLIN RUN ROAD
Mailing Address - Street 2:SUITE 208 PEDIATRIC ALLIANCE - ST. CLAIR DIVISION
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241
Mailing Address - Country:US
Mailing Address - Phone:412-221-2121
Mailing Address - Fax:412-221-7224
Practice Address - Street 1:1580 MCLAUGHLIN RUN ROAD
Practice Address - Street 2:SUITE 208 PEDIACTRIC ALLIANCE - ST. CLAIR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241
Practice Address - Country:US
Practice Address - Phone:412-221-2121
Practice Address - Fax:412-221-7224
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered