Provider Demographics
NPI:1144361049
Name:KIMOTO, BONNIE J (RD)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:KIMOTO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 APPLEGATE CT.
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2601
Mailing Address - Country:US
Mailing Address - Phone:847-688-4723
Mailing Address - Fax:847-688-2066
Practice Address - Street 1:3001A 6TH ST.
Practice Address - Street 2:NAVAL HEALTH CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3210
Practice Address - Country:US
Practice Address - Phone:847-688-4723
Practice Address - Fax:847-688-2066
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered