Provider Demographics
NPI:1629475041
Name:KHEMET, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:KHEMET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 MODOC ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4813
Mailing Address - Country:US
Mailing Address - Phone:415-900-8726
Mailing Address - Fax:
Practice Address - Street 1:828 MODOC ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-4813
Practice Address - Country:US
Practice Address - Phone:415-900-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment