Provider Demographics
NPI:1003078767
Name:KAHN, REBECCA GERBER (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GERBER
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:ERIN
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4201 NE 66TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3078
Mailing Address - Country:US
Mailing Address - Phone:360-823-4854
Mailing Address - Fax:360-449-4961
Practice Address - Street 1:4816 NE THURSTON WAY STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6661
Practice Address - Country:US
Practice Address - Phone:360-254-4914
Practice Address - Fax:360-892-1533
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD608242482085R0202X
OR1713372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0388090OtherLNI-RADIA
WA2062113Medicaid