Healthcare Provider Details

I. General information

NPI: 1972016947
Provider Name (Legal Business Name): HEATHER FAY KAHN DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER FAY KAHN DOM

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CALLECITA MEMBRENO
SANTA FE NM
87505-4951
US

IV. Provider business mailing address

2225 CALLECITA MEMBRENO
SANTA FE NM
87505-4951
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-1550
  • Fax:
Mailing address:
  • Phone: 505-660-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: