Provider Demographics
NPI:1336395037
Name:KROHN, JENNIFER PEARL (MMSC, PA, RDN, CDE)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PEARL
Last Name:KROHN
Suffix:
Gender:F
Credentials:MMSC, PA, RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14649 VICTORY BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4101
Mailing Address - Country:US
Mailing Address - Phone:818-786-8396
Mailing Address - Fax:
Practice Address - Street 1:14649 VICTORY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-4101
Practice Address - Country:US
Practice Address - Phone:818-786-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA975454133V00000X
CA61392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered