Healthcare Provider Details

I. General information

NPI: 1689069759
Provider Name (Legal Business Name): KAITLYN ANNE HARDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE G500
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4150 V ST STE G500
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number146675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: