Healthcare Provider Details

I. General information

NPI: 1467322719
Provider Name (Legal Business Name): KENNETH RYAN KOCHEMS AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 4TH ST STE 184
SANTA ANA CA
92701-5143
US

IV. Provider business mailing address

PO BOX 77184
CORONA CA
92877-0106
US

V. Phone/Fax

Practice location:
  • Phone: 714-453-4402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: