Healthcare Provider Details

I. General information

NPI: 1609133032
Provider Name (Legal Business Name): DANIEL BERNARD KENNEDY DHAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK HOLLIS HIGHWAY
KLAWOCK AK
99925
US

IV. Provider business mailing address

PO BOX 69
KLAWOCK AK
99925-0069
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4990
  • Fax: 907-755-4811
Mailing address:
  • Phone: 907-755-4990
  • Fax: 907-755-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier06-031-DHAT
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerCOMMUNITY HEALTH AIDE CERTIFICATION BOARD - FEDERAL CERTIFICATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: