Healthcare Provider Details

I. General information

NPI: 1083186472
Provider Name (Legal Business Name): KEVIN HAHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26708 RANCHO BUENA CIR
MORENO VALLEY CA
92555-4223
US

IV. Provider business mailing address

26708 RANCHO BUENA CIR
MORENO VALLEY CA
92555-4223
US

V. Phone/Fax

Practice location:
  • Phone: 951-570-6700
  • Fax:
Mailing address:
  • Phone: 951-570-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: