Provider Demographics
NPI:1346743028
Name:FUNK, KATHLEEN SANTOS (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SANTOS
Last Name:FUNK
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 NORTH BLVD APT 3205
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5124
Mailing Address - Country:US
Mailing Address - Phone:915-929-1900
Mailing Address - Fax:
Practice Address - Street 1:2020 NORTH LOOP W STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8103
Practice Address - Country:US
Practice Address - Phone:915-929-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty