Provider Demographics
NPI:1164918710
Name:KAGEDAN, DANIEL JONATHAN (BSC, MD, MSC, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JONATHAN
Last Name:KAGEDAN
Suffix:
Gender:M
Credentials:BSC, MD, MSC, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 QUEEN ST. WEST
Mailing Address - Street 2:APT 311N
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6J0A4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:665 ELM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1104
Practice Address - Country:US
Practice Address - Phone:716-845-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ98114208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery