Provider Demographics
NPI:1972016947
Name:KAHN, HEATHER FAY (DOM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FAY
Last Name:KAHN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:FAY
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:2225 CALLECITA MEMBRENO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4951
Mailing Address - Country:US
Mailing Address - Phone:505-660-1550
Mailing Address - Fax:
Practice Address - Street 1:2225 CALLECITA MEMBRENO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4951
Practice Address - Country:US
Practice Address - Phone:505-660-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist