Provider Demographics
NPI:1447073119
Name:KAHM, FARHAN MOHAMED
Entity type:Individual
Prefix:
First Name:FARHAN
Middle Name:MOHAMED
Last Name:KAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-4403
Mailing Address - Country:US
Mailing Address - Phone:651-890-7474
Mailing Address - Fax:
Practice Address - Street 1:1176 OAK ST
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-4403
Practice Address - Country:US
Practice Address - Phone:651-890-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health