Healthcare Provider Details

I. General information

NPI: 1548408354
Provider Name (Legal Business Name): BENJAMAN WUNDERLICH MS, RD, LD, CSSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859
US

V. Phone/Fax

Practice location:
  • Phone: 857-240-5591
  • Fax:
Mailing address:
  • Phone: 808-433-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number978297
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: