Healthcare Provider Details

I. General information

NPI: 1417330267
Provider Name (Legal Business Name): DR. KRISTOPHER CURTIS KERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date: 07/12/2019
Reactivation Date: 08/07/2019

III. Provider practice location address

2425 BISSO LN
CONCORD CA
94520-4897
US

IV. Provider business mailing address

2175 AWIKIWIKI ST
PEARL CITY HI
96782-1323
US

V. Phone/Fax

Practice location:
  • Phone: 925-521-5715
  • Fax:
Mailing address:
  • Phone: 808-479-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberUNLICENSED
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: