Healthcare Provider Details

I. General information

NPI: 1619218443
Provider Name (Legal Business Name): NIRAMOL CHANKITWANIT R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST LAC-USC HEALTHCARE NETWORK, DIETARY DEPARTMENT
LOS ANGELES CA
90033
US

IV. Provider business mailing address

945 S ORANGE GROVE BLVD APT . B
PASADENA CA
91105-1793
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6979
  • Fax:
Mailing address:
  • Phone: 323-409-6979
  • 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:
Title or Position:
Credential:
Phone: