Provider Demographics
NPI:1790662401
Name:KACHANOV, GERMAN
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:
Last Name:KACHANOV
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 1:7273 VIALE SONATA
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5231
Mailing Address - Country:US
Mailing Address - Phone:929-389-7679
Mailing Address - Fax:347-201-8309
Practice Address - Street 1:7273 VIALE SONATA
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5231
Practice Address - Country:US
Practice Address - Phone:929-389-7679
Practice Address - Fax:347-201-8309
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician