Healthcare Provider Details

I. General information

NPI: 1679633366
Provider Name (Legal Business Name): JENNIFER CHANTAL KUHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15814 S. WINCHESTER BLVD. SUITE #105
LOS GATOS CA
95030
US

IV. Provider business mailing address

15814 S. WINCHESTER BLVD. SUITE #105
LOS GATOS CA
95030
US

V. Phone/Fax

Practice location:
  • Phone: 408-402-2066
  • Fax:
Mailing address:
  • Phone: 408-402-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 22151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: