Provider Demographics
NPI:1578657623
Name:HAMM, KEVIN (DO,PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HAMM
Suffix:
Gender:M
Credentials:DO,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-0397
Mailing Address - Country:US
Mailing Address - Phone:316-755-0482
Mailing Address - Fax:316-755-0458
Practice Address - Street 1:629 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1928
Practice Address - Country:US
Practice Address - Phone:316-755-0482
Practice Address - Fax:316-755-0458
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-269682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-1235274OtherTAX ID #
KS05-26968OtherLISCENSE
KS100297360CMedicaid
KS058849OtherBCBS
KS058849Medicare ID - Type Unspecified
KS05-26968OtherLISCENSE