Provider Demographics
NPI:1295593978
Name:KOS, ALLA (RDN)
Entity type:Individual
Prefix:MS
First Name:ALLA
Middle Name:
Last Name:KOS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4424
Mailing Address - Country:US
Mailing Address - Phone:312-536-9799
Mailing Address - Fax:
Practice Address - Street 1:4525 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-4424
Practice Address - Country:US
Practice Address - Phone:312-536-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered