Provider Demographics
NPI:1790303642
Name:KIM, SUSAN CHOI (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CHOI
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 HOLLYDALE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2113
Mailing Address - Country:US
Mailing Address - Phone:213-446-6762
Mailing Address - Fax:
Practice Address - Street 1:1516 SAN PABLO ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-9551
Practice Address - Fax:323-865-9202
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86078757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered