Active NPI
Jack Dylan Kennedy, RD
- Registered Dietitian
- Chula Vista, CA
National Provider Identifier
1013899772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86296497
- Practice address
- 1237 Pinehurst Rd
Chula Vista, CA 91915-1245 - Phone
- (619) 917-9321
- NPI assigned
- Jul 23, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86296497 | CA | Primary |
Addresses
Primary practice location
1237 Pinehurst Rd
Chula Vista, CA 91915-1245
Mailing address
1237 Pinehurst Rd
Chula Vista, CA 91915-1245
Phone (619) 917-9321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86296497 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753228800000",
"number": "1013899772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1237 PINEHURST RD",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919151245",
"telephone_number": "619-917-9321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1237 PINEHURST RD",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919151245",
"telephone_number": "619-917-9321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "JACK",
"middle_name": "DYLAN",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-23",
"last_updated": "2025-07-23",
"certification_date": "2025-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86296497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
- Walter Kelly, H.I.S.
- Kelsey Barbieri, Licensed Clinical Social Worker, a Professional Corp
- Jordan Dean Wingfield Keltner
- Brian Anthony Kendrick, LCSW
- Gabrielle Kennedy, OTD, OTR/L
- Kenneth a. Romero, M.D., Inc
- Pamela Louise Kenney, M.D.
- Vivian Nishan Keorhagian
- Keri D.D.S a Professional Corporation
- Nazli Keri, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.