Provider Demographics
NPI:1093779035
Name:CAHILL, KIMBERLY (RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAHILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NORTH JUANITA AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2808
Mailing Address - Country:US
Mailing Address - Phone:310-683-9362
Mailing Address - Fax:
Practice Address - Street 1:710 N JUANITA AVE
Practice Address - Street 2:UNIT A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2226
Practice Address - Country:US
Practice Address - Phone:310-683-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA818408OtherAMERICAN DIETETIC ASSOCIA