Healthcare Provider Details

I. General information

NPI: 1326537382
Provider Name (Legal Business Name): BONNY JEAN KUHFAL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 05/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 TENNESSEE ST
VALLEJO CA
94590-4627
US

IV. Provider business mailing address

1534 TENNESSEE ST
VALLEJO CA
94590-4627
US

V. Phone/Fax

Practice location:
  • Phone: 707-554-6660
  • Fax:
Mailing address:
  • Phone: 707-554-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: