Provider Demographics
NPI:1245507912
Name:KING, CYNTHIA DELORES (RDN, LDN, CDE)
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:DELORES
Last Name:KING
Suffix:
Gender:F
Credentials:RDN, LDN, CDE
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:DELORES
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LDN, CDE
Mailing Address - Street 1:84-688 ALA MAHIKU ST
Mailing Address - Street 2:33-#157C
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:404-387-3884
Mailing Address - Fax:
Practice Address - Street 1:88-688 ALA MAHIKU ST
Practice Address - Street 2:33 #157C
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792
Practice Address - Country:US
Practice Address - Phone:404-387-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-24
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003707133V00000X
HI135-LD133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered