MEDICARE: DR. JOSEPHINE CHI KANNIKE-MARTINS DPA, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	133NN1002X
2	133V00000X	Registered Dietitian	133V00000X

General Provider Information

NPI Number	:	1265688923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE CHI KANNIKE-MARTINS DPA, RD

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR STE 417
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	323-295-1136
Fax Number	:	323-295-1071

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR STE 417
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	323-295-1136
Fax Number	:	323-295-1071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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