Provider Demographics
NPI:1457876815
Name:MENCH, DAVID KALANI (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KALANI
Last Name:MENCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 W MIDDLE FORK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6090
Mailing Address - Country:US
Mailing Address - Phone:808-754-2010
Mailing Address - Fax:
Practice Address - Street 1:3015 E MAGIC VIEW DR STE 115
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3743
Practice Address - Country:US
Practice Address - Phone:208-321-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2052363A00000X
HI1042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant