| Doctor Name: | IRYANTHI KURNIADI |
| NPI Number: | 1104163880 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | 883003 |
| Business Practice Address: | 18324 Jeffrey Ave Cerritos, CA - 907036149 |
| Business Phone Number: | 5627393944 |
| Business Fax Number: | |
| Mailing Address: | 18324 Jeffrey Ave, CERRITOS |
| State: | CA |
| Postal Code: | 907036149 |
| Phone Number: | 5627393944 |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2013 |
| NPI Last Update Date: | 01/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1005X |
| License Number: | 883003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Renal |
| Taxonomy Definition: | |