Kristian Taylor Johansen, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164008224 Issued in IL

Practice address

1114 Lake St
Oak Park, IL 60301-1002

Phone

(708) 383-1114

Fax

(312) 648-0155

NPI assigned

Jul 13, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Fitness Formula, LTD

  • Registered Dietitian
  • Chicago, IL
  • NPI 1033596440

  Dietitian, Registered

  NPD (past)
• Cloud Health Medical Group, P.a.

  • Internal Medicine Physician
  • White Plains, NY
  • NPI 1528744935
  NPD (past)
• Everfit Inc

  • Registered Dietitian
  • Spokane, WA
  • NPI 1346921814

  Dietitian, Registered

  NPD (past)
• Henry Ford Health Rochester Hospital

  • Neurology Physician
  • Rochester, MI
  • NPI 1366565442
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1811515232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011002",
            "telephone_number": "708-383-1114",
            "fax_number": "312-648-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011002",
            "telephone_number": "708-383-1114",
            "fax_number": "312-648-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "KRISTIAN",
        "middle_name": "TAYLOR",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164008224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://docs.google.com/document/d/14DyFFlY3hMyK_dM2OhCHH752DUJZkUFI8G6O67NcGJ0/edit?usp=sharing",
            "affiliation": "N",
            "address_1": "560 Westmore Meyers Rd",
            "city": "Lombard",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601483028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica B. Sittig, LCSW, LLC
• Chichao Jin, DMD
• Joan McDonald Therapy, PLLC
• Jodi Walker, Ma, CCC-SLP
• Joel Sherr SC
• John G Crawford DDS LTD
• John M. Hagen, PC
• Johnmc Care Venture Inc
• Lavangela Johnson Turner, LSW
• Alaina C Johnson, PSY.D.

• Registered Dietitian in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.