Provider Demographics
NPI:1881248698
Name:KINIKIN, JANAE (RDN)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:KINIKIN
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 1:828 W 4350 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3426
Mailing Address - Country:US
Mailing Address - Phone:385-244-9573
Mailing Address - Fax:
Practice Address - Street 1:828 W 4350 S
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3426
Practice Address - Country:US
Practice Address - Phone:385-244-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86101171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered