Provider Demographics
NPI:1619218443
Name:CHANKITWANIT, NIRAMOL (RD)
Entity Type:Individual
Prefix:MS
First Name:NIRAMOL
Middle Name:
Last Name:CHANKITWANIT
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 1:945 S ORANGE GROVE BLVD
Mailing Address - Street 2:APT . B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1793
Mailing Address - Country:US
Mailing Address - Phone:323-409-6979
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:LAC-USC HEALTHCARE NETWORK, DIETARY DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered