MEDICARE: GERMAN KACHANOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1790662401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERMAN KACHANOV

Provider Business Mailing Address
First Line	:	7273 VIALE SONATA
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-5231
Country	:	US
Telephone Number	:	929-389-7679
Fax Number	:	347-201-8309

Provider Business Practice Location Address
First Line	:	7273 VIALE SONATA
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-5231
Country	:	US
Telephone Number	:	929-389-7679
Fax Number	:	347-201-8309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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Directions to “ GERMAN KACHANOV ” Practice Location

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