Healthcare Provider Details

I. General information

NPI: 1689629057
Provider Name (Legal Business Name): ILAN KEDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 303
BEVERLY HILLS CA
90211-2283
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD STE 303
BEVERLY HILLS CA
90211-2283
US

V. Phone/Fax

Practice location:
  • Phone: 310-307-5555
  • Fax: 424-249-3103
Mailing address:
  • Phone: 310-307-5555
  • Fax: 424-249-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA93684
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD034206
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA93684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: