MEDICARE: DR. HENRY SCOTT KANE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	C1711481	CA
2	2084P0800X	Psychiatry Physician	C1711481	CA

General Provider Information

NPI Number	:	1609839273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY SCOTT KANE M.D.

Provider Business Mailing Address
First Line	:	780 BAY BLVD STE 203
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-5261
Country	:	US
Telephone Number	:	619-842-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 BAY BLVD STE 203
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-5261
Country	:	US
Telephone Number	:	619-842-2442
Fax Number	:	619-842-2443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/18/2024

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