Basic Information
| Provider Information | |||||||||
| NPI: | 1528235520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIGOZI | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 W ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902203500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105311337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 818 W ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902203500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105371337 | ||||||||
| FaxNumber: | 3107641011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2008 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 967976 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 00RD9679760 | 05 | CA | MEDICAID |