# KIDNEY NUTRITION CONSULT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659956241
- **Authorized official:** HAEWOOK HAN PHD,RD,CSR,LDN (OWNER)
- **Authorized official phone:** (617) 320-2804

## Contact information

- **Practice address:** 285 VICTORY RD, QUINCY, MA 02171-3137
- **Practice address phone:** (617) 320-2804
- **Mailing address:** 285 VICTORY RD, QUINCY, MA 02171-3137
- **Mailing address phone:** (617) 320-2804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1005X | Renal Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1005X | Renal Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2021
- **Last updated:** 05/03/2021