Provider Demographics
NPI:1629476353
Name:DHST INCORPORATED
Entity Type:Organization
Organization Name:DHST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-861-4378
Mailing Address - Street 1:5001 BIRCH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2116
Mailing Address - Country:US
Mailing Address - Phone:949-861-4378
Mailing Address - Fax:
Practice Address - Street 1:5001 BIRCH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2116
Practice Address - Country:US
Practice Address - Phone:949-861-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102522804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty