Provider Demographics
NPI:1578586509
Name:KEHM, SUSAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:KEHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3312
Mailing Address - Country:US
Mailing Address - Phone:530-895-0423
Mailing Address - Fax:530-895-1872
Practice Address - Street 1:1665 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3312
Practice Address - Country:US
Practice Address - Phone:530-895-0423
Practice Address - Fax:530-895-1872
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31224OtherMEDICAL LICENSE
CAGROO43570Medicaid
CAGROO43570Medicaid
CAA44694Medicare UPIN