Healthcare Provider Details

I. General information

NPI: 1942850730
Provider Name (Legal Business Name): KEVIN KUHLOW LAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LAWNVIEW CIR
DANVILLE CA
94526-5108
US

IV. Provider business mailing address

7052 SANTA TERESA BLVD STE 1044
SAN JOSE CA
95139-1348
US

V. Phone/Fax

Practice location:
  • Phone: 650-290-2280
  • Fax:
Mailing address:
  • Phone: 855-478-4357
  • Fax: 541-897-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR10010621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: