Active NPI
Myra Ichikawa, RDN
- Registered Dietitian
- Harbor City, CA
National Provider Identifier
1811735459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1058374
- Practice address
- 25825 Vermont Ave
Harbor City, CA 90710-3518 - Phone
- (310) 944-0745
- NPI assigned
- Jul 17, 2024
- 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 | 1058374 | CA | Primary |
Addresses
Primary practice location
25825 Vermont Ave
Harbor City, CA 90710-3518
Mailing address
1250 W 168TH St Apt 3
Gardena, CA 90247-5551
Phone (310) 944-0745
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 |
|---|---|---|---|
| 1058374 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722729600000",
"number": "1811735459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 W 168TH ST APT 3",
"city": "GARDENA",
"state": "CA",
"postal_code": "902475551",
"telephone_number": "310-944-0745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25825 VERMONT AVE",
"city": "HARBOR CITY",
"state": "CA",
"postal_code": "907103518",
"telephone_number": "310-944-0745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHIKAWA",
"first_name": "MYRA",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-17",
"last_updated": "2024-08-04",
"certification_date": "2024-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "1058374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harbor City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.