Healthcare Provider Details

I. General information

NPI: 1720013907
Provider Name (Legal Business Name): MYRA JOYCE KAHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 VAN NUYS BLVD
VAN NUYS CA
91605-1949
US

IV. Provider business mailing address

7515 VAN NUYS BLVD
VAN NUYS CA
91605-1949
US

V. Phone/Fax

Practice location:
  • Phone: 818-947-4026
  • Fax: 818-949-8850
Mailing address:
  • Phone: 818-947-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG14391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: