Provider Demographics
NPI:1376366922
Name:JOSEPH, KIARA (RD, LD)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N LAKE SHORE DR APT 17K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6633
Mailing Address - Country:US
Mailing Address - Phone:630-542-8132
Mailing Address - Fax:
Practice Address - Street 1:1400 N LAKE SHORE DR APT 17K
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6633
Practice Address - Country:US
Practice Address - Phone:630-542-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86374110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered