Healthcare Provider Details

I. General information

NPI: 1164719027
Provider Name (Legal Business Name): KATHRYN ELIZABETH HENNING M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 KATELLA AVE
LOS ALAMITOS CA
90720-3302
US

IV. Provider business mailing address

123 S CORNELL AVE
FULLERTON CA
92831-4521
US

V. Phone/Fax

Practice location:
  • Phone: 714-334-2480
  • Fax: 714-578-0043
Mailing address:
  • Phone: 714-334-2480
  • Fax: 714-578-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number00931156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: