Provider Demographics
NPI:1720047699
Name:HOUCHIN, KENNETH W (M D)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:HOUCHIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3414
Mailing Address - Country:US
Mailing Address - Phone:775-738-5193
Mailing Address - Fax:775-778-6831
Practice Address - Street 1:875 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3414
Practice Address - Country:US
Practice Address - Phone:775-738-5193
Practice Address - Fax:775-778-6831
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8896207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF15850Medicare UPIN
NV31874Medicare ID - Type UnspecifiedELKO MEDICARE
NV37464Medicare ID - Type UnspecifiedLAS VEGAS MEDICARE
NV1325980001Medicare NSC