Healthcare Provider Details

I. General information

NPI: 1316287766
Provider Name (Legal Business Name): DHST, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 BIRCH ST SUITE 8
NEWPORT BEACH CA
92660-2116
US

IV. Provider business mailing address

5001 BIRCH ST SUITE 8
NEWPORT BEACH CA
92660-2116
US

V. Phone/Fax

Practice location:
  • Phone: 949-861-4378
  • Fax: 949-861-4378
Mailing address:
  • Phone: 949-861-4378
  • Fax: 949-861-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM EARL KENNAMORE
Title or Position: FOUNDER/CEO
Credential: MASSAGE THERAPIST
Phone: 949-514-4561