Provider Demographics
NPI:1083688113
Name:KAHN, LAWRENCE STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E GUADALUPE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5116
Mailing Address - Country:US
Mailing Address - Phone:480-507-0600
Mailing Address - Fax:480-558-7162
Practice Address - Street 1:2450 E GUADALUPE RD
Practice Address - Street 2:STE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5116
Practice Address - Country:US
Practice Address - Phone:480-507-0600
Practice Address - Fax:480-558-7162
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15637207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0869330OtherBLUE CROSS BLUE SHIELD
AZ2574035OtherAHCCCS
AZD37106Medicare UPIN
AZAZ0869330OtherBLUE CROSS BLUE SHIELD