Healthcare Provider Details

I. General information

NPI: 1740860659
Provider Name (Legal Business Name): KIND KIDNEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 12/09/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 E COLORADO BLVD # 2501
PASADENA CA
91101-1903
US

IV. Provider business mailing address

281 E COLORADO BLVD # 2501
PASADENA CA
91101-1903
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-4225
  • Fax: 626-628-3050
Mailing address:
  • Phone: 818-207-4225
  • Fax: 626-628-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA LYNN PERREIRA-PICO
Title or Position: CO-OWNER
Credential: RDN
Phone: 818-207-4225