Provider Demographics
NPI:1609944271
Name:KENNETH S HAHN
Entity Type:Organization
Organization Name:KENNETH S HAHN
Other - Org Name:REDOUBT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-283-6030
Mailing Address - Street 1:11472 KENAI SPUR HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7779
Mailing Address - Country:US
Mailing Address - Phone:907-283-6030
Mailing Address - Fax:907-283-3194
Practice Address - Street 1:11472 KENAI SPUR HWY STE 2
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7779
Practice Address - Country:US
Practice Address - Phone:907-283-6030
Practice Address - Fax:907-283-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152109Medicare ID - Type UnspecifiedMEDICARE