Basic Information
| Provider Information | |||||||||
| NPI: | 1245727320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAHN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 ZONAL AVENUE | ||||||||
| Address2: | IRD 7TH FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900890121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234097184 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14445 OLIVE VIEW DR DEPT OF | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472103205 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2018 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A164953 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.