Provider Demographics
NPI:1730381120
Name:KARDOUNI, DANIEL JACOB (MA,LD,RD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:KARDOUNI
Suffix:
Gender:M
Credentials:MA,LD,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2432
Mailing Address - Country:US
Mailing Address - Phone:740-588-1178
Mailing Address - Fax:
Practice Address - Street 1:719 LENOX AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2432
Practice Address - Country:US
Practice Address - Phone:740-588-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD. 5844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered