Provider Demographics
NPI:1104083419
Name:KUCHENOFF, LOU J (CHA-III)
Entity type:Individual
Prefix:
First Name:LOU
Middle Name:J
Last Name:KUCHENOFF
Suffix:
Gender:F
Credentials:CHA-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1436
Practice Address - Street 1:172 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661
Practice Address - Country:US
Practice Address - Phone:907-383-3151
Practice Address - Fax:907-383-5688
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG926Medicaid