Healthcare Provider Details

I. General information

NPI: 1992818850
Provider Name (Legal Business Name): KATHRYN J HAHN D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR SUITE 502 B
SANTA FE NM
87505-5459
US

IV. Provider business mailing address

1030 VALERIE CIR
SANTA FE NM
87507-5055
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-0157
  • Fax: 505-474-0496
Mailing address:
  • Phone: 505-412-0157
  • Fax: 505-474-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: