Provider Demographics
NPI:1366086639
Name:KAHM CLINIC LLC
Entity type:Organization
Organization Name:KAHM CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-881-2936
Mailing Address - Street 1:1474 ETHAN ALLEN HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9569
Mailing Address - Country:US
Mailing Address - Phone:802-881-2936
Mailing Address - Fax:
Practice Address - Street 1:288 WALNUT ST STE 412
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1994
Practice Address - Country:US
Practice Address - Phone:802-881-2936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty