Basic Information
| Provider Information | |||||||||
| NPI: | 1003078767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAHN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | GERBER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GERBER | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | ERIN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4201 NE 66TH AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608234854 | ||||||||
| FaxNumber: | 3604494961 | ||||||||
| Practice Location | |||||||||
| Address1: | 4816 NE THURSTON WAY STE A | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602544914 | ||||||||
| FaxNumber: | 3608921533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD60824248 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0388090 | 01 | WA | LNI-RADIA | OTHER | 2062113 | 05 | WA | MEDICAID |