Active NPI
Jane Kwak
- Registered Dietitian
- Northridge, CA
National Provider Identifier
1851174908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86048210
- Practice address
- 17730 Lassen St Apt 318
Northridge, CA 91325-4771 - Phone
- (626) 404-4250
- NPI assigned
- Aug 14, 2023
- 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 | 86048210 | CA | Primary |
Addresses
Primary practice location
17730 Lassen St Apt 318
Northridge, CA 91325-4771
Mailing address
17730 Lassen St Apt 318
Northridge, CA 91325-4771
Phone (626) 404-4250
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 |
|---|---|---|---|
| 86048210 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1851174908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17730 LASSEN ST APT 318",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913254771",
"telephone_number": "626-404-4250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17730 LASSEN ST APT 318",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913254771",
"telephone_number": "626-404-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "JANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-14",
"certification_date": "2023-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86048210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.