Provider Demographics
NPI:1275904450
Name:KING VANOVER, KYLIE (MS, RD)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KING VANOVER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD
Mailing Address - Street 1:12946 VALLEYHEART DRIVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1971
Mailing Address - Country:US
Mailing Address - Phone:323-422-0222
Mailing Address - Fax:
Practice Address - Street 1:3401 BARHAM BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1289
Practice Address - Country:US
Practice Address - Phone:323-422-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered