Provider Demographics
NPI:1881723260
Name:KASSEBAUM, THOMAS AKIN (HHP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:AKIN
Last Name:KASSEBAUM
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8780 BETELGEUSE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1404
Mailing Address - Country:US
Mailing Address - Phone:858-566-0943
Mailing Address - Fax:858-566-0943
Practice Address - Street 1:9265 ACTIVITY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4444
Practice Address - Country:US
Practice Address - Phone:858-578-5775
Practice Address - Fax:858-578-5794
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath