Healthcare Provider Details

I. General information

NPI: 1942263272
Provider Name (Legal Business Name): KENNETH H KAHN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 HOSPITAL DR SUITE 201B
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

1692 HOSPITAL DR SUITE 201B
SANTA FE NM
87505-4754
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1187
  • Fax:
Mailing address:
  • Phone: 505-988-1187
  • Fax: 505-986-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1444
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: