Provider Demographics
NPI:1902276868
Name:AHN, EUNJEE (RDN)
Entity Type:Individual
Prefix:
First Name:EUNJEE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CEDAR ST
Mailing Address - Street 2:2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3521
Mailing Address - Country:US
Mailing Address - Phone:413-230-4222
Mailing Address - Fax:
Practice Address - Street 1:208 CEDAR ST
Practice Address - Street 2:2
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3521
Practice Address - Country:US
Practice Address - Phone:413-230-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU3792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered