Provider Demographics
NPI:1528465705
Name:KAHN, JACOB B (BA)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:B
Last Name:KAHN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 INVERNESS DR W
Mailing Address - Street 2:#B 302
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5026
Mailing Address - Country:US
Mailing Address - Phone:240-535-4850
Mailing Address - Fax:
Practice Address - Street 1:2460 S VINE ST
Practice Address - Street 2:(303) 871-3736
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:303-871-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health