Healthcare Provider Details

I. General information

NPI: 1629475041
Provider Name (Legal Business Name): KERRY KHEMET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 MODOC ST
VALLEJO CA
94591-4813
US

IV. Provider business mailing address

828 MODOC ST
VALLEJO CA
94591-4813
US

V. Phone/Fax

Practice location:
  • Phone: 415-900-8726
  • Fax:
Mailing address:
  • Phone: 415-900-8726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: