Healthcare Provider Details

I. General information

NPI: 1528591385
Provider Name (Legal Business Name): LUCY KAHN EGESDAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCY ELINOR KAHN DO

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST STE 201
LONG BEACH CA
90806-1620
US

IV. Provider business mailing address

455 E COLUMBIA ST STE 201
LONG BEACH CA
90806-1607
US

V. Phone/Fax

Practice location:
  • Phone: 844-822-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDOS-2403
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A16907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: