Provider Demographics
NPI:1326362856
Name:SANGER, KIAH SUZANNE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KIAH
Middle Name:SUZANNE
Last Name:SANGER
Suffix:
Gender:
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E MAIN ST STE 400-110
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6004
Mailing Address - Country:US
Mailing Address - Phone:541-531-9548
Mailing Address - Fax:
Practice Address - Street 1:122 E MAIN ST STE 400-110
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-6004
Practice Address - Country:US
Practice Address - Phone:541-531-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1006X
OR10254746133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic