Provider Demographics
NPI:1992521553
Name:CHERRY BLOSSOM NUTRITION RDN PC
Entity type:Organization
Organization Name:CHERRY BLOSSOM NUTRITION RDN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:617-657-9877
Mailing Address - Street 1:13635 CIMARRON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2499
Mailing Address - Country:US
Mailing Address - Phone:617-657-9877
Mailing Address - Fax:866-657-4321
Practice Address - Street 1:13635 CIMARRON AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2499
Practice Address - Country:US
Practice Address - Phone:617-657-9877
Practice Address - Fax:866-657-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty