Provider Demographics
NPI:1821220203
Name:KAHN, KENNETH RAY SR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:KAHN
Suffix:SR
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 1:2100 NAPA VALLEJO HWY BLDG 253M1M2
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6234
Mailing Address - Country:US
Mailing Address - Phone:707-257-1460
Mailing Address - Fax:707-257-7524
Practice Address - Street 1:2100 NAPA VALLEJO HWY BLDG 253M1M2
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-257-1460
Practice Address - Fax:707-257-7524
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor