Healthcare Provider Details

I. General information

NPI: 1134066616
Provider Name (Legal Business Name): KAM HAIR LOSS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 AIRPORT RD STE D
ARDEN NC
28704-8333
US

IV. Provider business mailing address

140 AIRPORT RD STE D
ARDEN NC
28704-8333
US

V. Phone/Fax

Practice location:
  • Phone: 828-785-3509
  • Fax:
Mailing address:
  • Phone: 828-785-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KELLY MAXWELL
Title or Position: OWNER
Credential:
Phone: 828-551-1225