Provider Demographics
NPI:1902294283
Name:DENKHAUS, KIM (MS, RD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DENKHAUS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WILSHIRE BLVD STE 1490
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5212
Mailing Address - Country:US
Mailing Address - Phone:424-234-3365
Mailing Address - Fax:
Practice Address - Street 1:785 MARKET ST
Practice Address - Street 2:SUITE 620
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2003
Practice Address - Country:US
Practice Address - Phone:424-234-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83507133V00000X
CA86055119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered