Provider Demographics
NPI:1679299259
Name:YADA, KRISTINE EMIKO
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:EMIKO
Last Name:YADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ROLLING GRN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3550
Mailing Address - Country:US
Mailing Address - Phone:949-351-3361
Mailing Address - Fax:
Practice Address - Street 1:18 VALENTE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1633
Practice Address - Country:US
Practice Address - Phone:949-351-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86209797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered