Healthcare Provider Details

I. General information

NPI: 1609750694
Provider Name (Legal Business Name): PHOEBE KAHOME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W SANTA CRUZ WAY
MOUNTAIN HOUSE CA
95391-1178
US

IV. Provider business mailing address

153 W SANTA CRUZ WAY
MOUNTAIN HOUSE CA
95391-1178
US

V. Phone/Fax

Practice location:
  • Phone: 916-397-1698
  • Fax:
Mailing address:
  • Phone: 916-397-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95022271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: