Active NPI
Kimberly J Whelan, RD
- Registered Dietitian
- San Jose, CA
National Provider Identifier
1356601017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 926569
- Practice address
- 2211 Moorpark Ave Ste 218
San Jose, CA 95128-2629 - Phone
- (408) 998-2325
- NPI assigned
- May 29, 2012
- Sex
- Female
- Sole proprietor
- No
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 | 926569 | CA | Primary |
Addresses
Primary practice location
2211 Moorpark Ave Ste 218
San Jose, CA 95128-2629
Mailing address
PO Box 33093
Los Gatos, CA 95031
Phone (831) 818-4462
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 926569 | Other | CA | REGISTERED DIETITIAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 926569 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Current | Accepting new patients |
| Bay Area Community Diabetes Educators LLC | Dietitian, Registered | Past | Accepting new patients |
Locations
500 Westover Dr
Sanford, NC 27330
Phone (478) 766-4000
3724 Jefferson St
Ste 104
Austin, TX 78731
Phone (512) 399-9039
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Registered Dietitian
- San Jose, CA
- NPI 1902132806
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338249600000",
"number": "1356601017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 33093",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "95031",
"telephone_number": "831-818-4462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 MOORPARK AVE STE 218",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282629",
"telephone_number": "408-998-2325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHELAN",
"first_name": "KIMBERLY",
"middle_name": "J",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-29",
"last_updated": "2012-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "926569",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED DIETITIAN",
"identifier": "926569",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.