Provider Demographics
NPI:1073008405
Name:DUNHAM, KENNETH CLAUDE JR (PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CLAUDE
Last Name:DUNHAM
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 CABRILLO ST BLDG 422
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3201
Mailing Address - Country:US
Mailing Address - Phone:510-551-8225
Mailing Address - Fax:
Practice Address - Street 1:473 CABRILLO ST BLDG 422
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3201
Practice Address - Country:US
Practice Address - Phone:510-551-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201803763NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health