Provider Demographics
NPI:1134124050
Name:KAHN, HEATHER ALAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ALAINE
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 NE 7TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1450
Mailing Address - Country:US
Mailing Address - Phone:541-244-2197
Mailing Address - Fax:541-244-2199
Practice Address - Street 1:1215 NE 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1450
Practice Address - Country:US
Practice Address - Phone:541-244-2197
Practice Address - Fax:541-244-2199
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297667Medicaid
ORR121605Medicare ID - Type Unspecified
OR297667Medicaid