1255633277 NPI number — HAESUN HWANG NUTRITION CONSULTING LLC

Table of content: (NPI 1255633277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255633277 NPI number — HAESUN HWANG NUTRITION CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAESUN HWANG NUTRITION CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255633277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11432 CHARTRES WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-0980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-274-1034
Provider Business Mailing Address Fax Number:
703-774-3923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 STEVENSON AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-274-1034
Provider Business Practice Location Address Fax Number:
703-774-3923
Provider Enumeration Date:
11/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HWANG
Authorized Official First Name:
HAESUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
571-274-1034

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  S345186-3 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com