Healthcare Provider Details

I. General information

NPI: 1144600115
Provider Name (Legal Business Name): KIMBERLY ANN KELLY ND, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 05/13/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 610
BEVERLY HILLS CA
90211-2006
US

IV. Provider business mailing address

22287 MULHOLLAND HWY # 669
CALABASAS CA
91302-5157
US

V. Phone/Fax

Practice location:
  • Phone: 424-389-9451
  • Fax: 833-551-4828
Mailing address:
  • Phone: 747-263-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1106458
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: