Provider Demographics
NPI:1225290489
Name:HABERMAN, KEN (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:34612 6TH AVE S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8723
Mailing Address - Country:US
Mailing Address - Phone:253-927-1882
Mailing Address - Fax:253-927-1439
Practice Address - Street 1:34612 6TH AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8723
Practice Address - Country:US
Practice Address - Phone:253-927-1882
Practice Address - Fax:253-927-1439
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA119113208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology