Provider Demographics
NPI:1427735448
Name:GUDKOVA, YULIYA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:GUDKOVA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 W MONTROSE AVE UNIT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1095
Mailing Address - Country:US
Mailing Address - Phone:312-731-8656
Mailing Address - Fax:
Practice Address - Street 1:VIRTUAL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1095
Practice Address - Country:US
Practice Address - Phone:312-380-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty