Healthcare Provider Details

I. General information

NPI: 1518551563
Provider Name (Legal Business Name): SKJ NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 KATELLA AVE
LOS ALAMITOS CA
90720-3302
US

IV. Provider business mailing address

3810 KATELLA AVE
LOS ALAMITOS CA
90720-3302
US

V. Phone/Fax

Practice location:
  • Phone: 714-334-2480
  • Fax: 562-598-9527
Mailing address:
  • Phone: 714-334-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN HENNING
Title or Position: OWNER
Credential: RD
Phone: 714-334-2480