Provider Demographics
NPI:1578657003
Name:KAHN, DANA DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:DENISE
Last Name:KAHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 4TH. ST.
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-721-4422
Mailing Address - Fax:415-460-2730
Practice Address - Street 1:1299 4TH. ST.
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-721-4422
Practice Address - Fax:415-460-2730
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical