=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275812380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR DIGESTIVE HEALTH & NUTRITIONAL EXCELLENCE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2011
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23600 TELO AVE SUITE #260
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-234-1840
-----------------------------------------------------
Fax | 866-591-7297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23600 TELO AVE SUITE #260
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-234-1840
-----------------------------------------------------
Fax | 866-591-7297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DORON D KAHANA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 424-234-1840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | A91621
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number | A91621
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------