Provider Demographics
NPI:1932237500
Name:THAKORE, KANAN YATIN (RD,CNSD)
Entity Type:Individual
Prefix:MS
First Name:KANAN
Middle Name:YATIN
Last Name:THAKORE
Suffix:
Gender:F
Credentials:RD,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RUES LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3859
Mailing Address - Country:US
Mailing Address - Phone:732-651-8538
Mailing Address - Fax:718-304-1177
Practice Address - Street 1:11 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3859
Practice Address - Country:US
Practice Address - Phone:732-651-8538
Practice Address - Fax:718-304-1177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL700931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered