=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144600115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY ANN KELLY ND, RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 05/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8920 WILSHIRE BLVD STE 610
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-389-9451
-----------------------------------------------------
Fax | 833-551-4828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22287 MULHOLLAND HWY # 669
-----------------------------------------------------
City | CALABASAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91302-5157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-263-9451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 1106458
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | ND1328
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------