Healthcare Provider Details

I. General information

NPI: 1619412095
Provider Name (Legal Business Name): KAHM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S WINOOSKI AVE
BURLINGTON VT
05401-3898
US

IV. Provider business mailing address

70 S WINOOSKI AVE
BURLINGTON VT
05401-3898
US

V. Phone/Fax

Practice location:
  • Phone: 802-881-2936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: PROF. NICHOLAS KAHM
Title or Position: PARTNER
Credential: PHD
Phone: 802-881-2936