Provider Demographics
NPI:1174550214
Name:DOCKAN, KRISTEN (AUD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DOCKAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM, AUDIOLOGY SERVICE 126
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DR.
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161
Mailing Address - Country:US
Mailing Address - Phone:858-552-7564
Mailing Address - Fax:858-642-6281
Practice Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM, AUDIOLOGY SERVICE 126
Practice Address - Street 2:3350 LA JOLLA VILLAGE DR.
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161
Practice Address - Country:US
Practice Address - Phone:858-552-7564
Practice Address - Fax:858-642-6281
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1894231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist