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General NPI Number Information
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NPI Number | 1083413058
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Entity Type | Individual
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Provider Name | CHRISTIAN KENSHIN JOB
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Gender | Male
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 925 BEVINS CT
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City | LAKEPORT
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State | CA
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Zip | 95453-9754
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Country | US
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Telephone | 707-263-8382
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Fax |
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Provider Business Mailing Address
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Address Line | 925 BEVINS CT
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City | LAKEPORT
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State | CA
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Zip | 95453-9754
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Country | US
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Telephone | 707-263-8382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 701025
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 701025
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 701025
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License Number State | CA
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