Koran Watson Haven of Health LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

KORAN WATSON HAVEN OF HEALTH LLC

Practice address

21 S 11TH St
Philadelphia, PA 19107-4223

Phone

(267) 209-3245

Fax

(267) 907-8591

NPI assigned

Mar 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Koran Watson, RDN LDNNPI 1174162572

Title

Owner/ Ceo

Phone

(267) 209-3245

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Koran Bianca Watson

  • Registered Dietitian
  • Philadelphia, PA
  • NPI 1174162572
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1104401322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074223",
            "telephone_number": "267-209-3245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074223",
            "telephone_number": "267-209-3245",
            "fax_number": "267-907-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORAN WATSON HAVEN OF HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "KORAN",
        "authorized_official_title_or_position": "OWNER/ CEO",
        "authorized_official_telephone_number": "267-209-3245",
        "authorized_official_credential": "RDN LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Koppisch, MSW
• Kristin Kopple, PH.D.
• Marijan Koprivanac, M.D.
• Sharon J. Kopyc
• Korah Consulting, Inc
• Eldoe Arthumngal Korathu, LCSW
• Yasmin Ahmed Korayem, MD
• Matthew Gerard Korber, PHARM.D.
• Jared Korelitz Golant
• David Ethan Koren, PHARM.D.

• Registered Dietitian in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.