Healthcare Provider Details

I. General information

NPI: 1619958626
Provider Name (Legal Business Name): CLIFFORD ROBERT KAHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CLIFFORD KAHN

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 VENTURA BLVD SUITE 203
ENCINO CA
91316-5109
US

IV. Provider business mailing address

17525 VENTURA BLVD SUITE 203
ENCINO CA
91316-5109
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-3366
  • Fax: 818-986-3866
Mailing address:
  • Phone: 818-986-3366
  • Fax: 818-986-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6268120001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG34659
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberG34659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: