Healthcare Provider Details

I. General information

NPI: 1659887685
Provider Name (Legal Business Name): KATHRYN J HAHN, DOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 502B
SANTA FE NM
87505-5559
US

IV. Provider business mailing address

1925 ASPEN DR STE 502B
SANTA FE NM
87505-5559
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-5077
  • Fax: 505-216-0866
Mailing address:
  • Phone: 505-216-5077
  • Fax: 505-216-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number771
License Number StateNM

VIII. Authorized Official

Name: KATHRYN J HAHN
Title or Position: OWNER
Credential: DOM
Phone: 505-216-5077