Provider Demographics
NPI:1538437447
Name:HOGAN, KATHERINE B (LAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RUGBY RD APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5665
Mailing Address - Country:US
Mailing Address - Phone:619-398-6580
Mailing Address - Fax:
Practice Address - Street 1:390 RUGBY RD APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5665
Practice Address - Country:US
Practice Address - Phone:619-398-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004723171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist