Provider Demographics
NPI:1326119173
Name:KAHN, JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 7TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5265
Mailing Address - Country:US
Mailing Address - Phone:707-546-4349
Mailing Address - Fax:707-528-0137
Practice Address - Street 1:509 7TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5265
Practice Address - Country:US
Practice Address - Phone:707-546-4349
Practice Address - Fax:707-528-0137
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical