Provider Demographics
NPI:1790377554
Name:KHT
Entity Type:Organization
Organization Name:KHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LACUESTA
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-469-9005
Mailing Address - Street 1:1566 E HAZELTINE ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7242
Mailing Address - Country:US
Mailing Address - Phone:562-469-9005
Mailing Address - Fax:
Practice Address - Street 1:1566 E HAZELTINE ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7242
Practice Address - Country:US
Practice Address - Phone:562-469-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care