Provider Demographics
NPI:1154339059
Name:KANE, KATHERINE CARMEL (RDHAP)
Entity type:Individual
Prefix:MR
First Name:KATHERINE
Middle Name:CARMEL
Last Name:KANE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SQUIRREL CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5762
Mailing Address - Country:US
Mailing Address - Phone:707-235-6229
Mailing Address - Fax:707-545-0745
Practice Address - Street 1:527 SQUIRREL CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5762
Practice Address - Country:US
Practice Address - Phone:707-235-6229
Practice Address - Fax:707-545-0745
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP78124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522891Medicaid
CA167083OtherDELTA DENTAL