Provider Demographics
NPI:1396590899
Name:KACHIRA, JOHNCY JOHN (MBBS, MPH)
Entity type:Individual
Prefix:
First Name:JOHNCY
Middle Name:JOHN
Last Name:KACHIRA
Suffix:
Gender:F
Credentials:MBBS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BROADWAY AVE S APT 225
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6970
Mailing Address - Country:US
Mailing Address - Phone:214-564-8116
Mailing Address - Fax:
Practice Address - Street 1:1555 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4555
Practice Address - Country:US
Practice Address - Phone:320-240-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine