=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427280015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRY S KAHN M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2009
-----------------------------------------------------
Last Update Date | 05/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17525 VENTURA BOULEVARD STE. 203
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-986-3366
-----------------------------------------------------
Fax | 818-986-3866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17525 VENTURA BLVD. STE 203
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-986-3366
-----------------------------------------------------
Fax | 818-986-3866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. TERI A CLIFTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-986-3366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | C11128
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------