Provider Demographics
NPI:1376914721
Name:KIM, JESSICA D (MPH, RD, CD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:D
Last Name:KIM
Suffix:
Gender:F
Credentials:MPH, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY
Mailing Address - Street 2:STE 800
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4396
Mailing Address - Country:US
Mailing Address - Phone:206-215-6670
Mailing Address - Fax:206-215-3099
Practice Address - Street 1:751 NE BLAKELY DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:425-313-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60488126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered