Healthcare Provider Details

I. General information

NPI: 1275222887
Provider Name (Legal Business Name): JENNIFER KAHANANUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 HAMRICK RD
CENTRAL POINT OR
97502-2816
US

IV. Provider business mailing address

3126 STATE ST STE 100
MEDFORD OR
97504-8665
US

V. Phone/Fax

Practice location:
  • Phone: 541-727-7669
  • Fax:
Mailing address:
  • Phone: 458-225-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number23-QMHA-R-3577
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: