Provider Demographics
NPI:1447276530
Name:JAHNKE, LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:JAHNKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CHAPALA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3911
Mailing Address - Country:US
Mailing Address - Phone:805-569-5658
Mailing Address - Fax:805-687-2840
Practice Address - Street 1:2412 CHAPALA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3911
Practice Address - Country:US
Practice Address - Phone:805-569-5658
Practice Address - Fax:805-687-2840
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G668270Medicaid
CAWG66827AMedicare ID - Type Unspecified
CA000G668270Medicaid