Provider Demographics
NPI:1326289026
Name:JONES, OKEUM S (RD, CDE, PHD)
Entity Type:Individual
Prefix:
First Name:OKEUM
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:RD, CDE, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1709
Mailing Address - Country:US
Mailing Address - Phone:818-843-7591
Mailing Address - Fax:
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1404
Practice Address - Country:US
Practice Address - Phone:213-388-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85007849133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered