Provider Demographics
NPI:1720260912
Name:KAN, SELENA (RN)
Entity type:Individual
Prefix:MISS
First Name:SELENA
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2647 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1537
Practice Address - Country:US
Practice Address - Phone:510-434-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN524719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse