MEDICARE: KYLIE KING VANOVER M.S., R.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
3	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1275904450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE KING VANOVER M.S., R.D.

Provider Business Mailing Address
First Line	:	12946 VALLEYHEART DRIVE
Second Line	:	SUITE 213
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-1971
Country	:	US
Telephone Number	:	323-422-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 BARHAM BLVD
Second Line	:	SUITE 4
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1289
Country	:	US
Telephone Number	:	323-422-0222
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	11/03/2020

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