Provider Demographics
NPI:1003781022
Name:MOUKADDAM, KARIM (MS, RDN)
Entity type:Individual
Prefix:
First Name:KARIM
Middle Name:
Last Name:MOUKADDAM
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6637 VALLEY HI DR APT 374
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7033
Mailing Address - Country:US
Mailing Address - Phone:719-310-3689
Mailing Address - Fax:
Practice Address - Street 1:3102 O ST STE 5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6544
Practice Address - Country:US
Practice Address - Phone:719-310-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered