Provider Demographics
NPI:1073182713
Name:DAM, KELVIN (RD)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:
Last Name:DAM
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SW GREENWICH DR # 174
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4408
Mailing Address - Country:US
Mailing Address - Phone:816-867-0867
Mailing Address - Fax:
Practice Address - Street 1:312 SW GREENWICH DR # 174
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4408
Practice Address - Country:US
Practice Address - Phone:816-867-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach