Individual
HWAN S TAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15806 76TH AVE APT 1B, FRESH MEADOWS, NY 11366-1059
(718) 458-4159
Mailing address
15806 76TH AVE APT 1B, FRESH MEADOWS, NY 11366-1059
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1040199
IL
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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