Provider Demographics
NPI:1609750694
Name:KAHOME, PHOEBE
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:KAHOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W SANTA CRUZ WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1178
Mailing Address - Country:US
Mailing Address - Phone:916-397-1698
Mailing Address - Fax:
Practice Address - Street 1:153 W SANTA CRUZ WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-1178
Practice Address - Country:US
Practice Address - Phone:916-397-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022271163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical