=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578657003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA DENISE KAHN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1299 4TH. ST. SUITE 307
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-721-4422
-----------------------------------------------------
Fax | 415-460-2730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1299 4TH. ST. SUITE 307
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-721-4422
-----------------------------------------------------
Fax | 415-460-2730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY14576
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------