Provider Demographics
NPI:1790804722
Name:KAHN, VICKI (LAC, LPTA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:KAHN
Suffix:
Gender:F
Credentials:LAC, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 SW 17TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-504-0250
Mailing Address - Fax:
Practice Address - Street 1:916 SW 17TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-504-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist