Provider Demographics
NPI:1396202339
Name:GHANAYEM, KATHLEEN MARY
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:GHANAYEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT, RCP, CPFT
Mailing Address - Street 1:2350 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3305
Mailing Address - Country:US
Mailing Address - Phone:415-833-8525
Mailing Address - Fax:415-833-5731
Practice Address - Street 1:2350 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3305
Practice Address - Country:US
Practice Address - Phone:415-833-8525
Practice Address - Fax:415-833-5731
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6642279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics