Provider Demographics
NPI:1194026963
Name:MADELYN KAHN MD PROF CORP
Entity Type:Organization
Organization Name:MADELYN KAHN MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-749-1939
Mailing Address - Street 1:18701 TIFFENI DR
Mailing Address - Street 2:STE 1A
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9406
Mailing Address - Country:US
Mailing Address - Phone:209-586-1400
Mailing Address - Fax:209-586-6748
Practice Address - Street 1:390 LAUREL ST
Practice Address - Street 2:STE. 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1980
Practice Address - Country:US
Practice Address - Phone:415-749-1939
Practice Address - Fax:415-749-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G525310261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G525310Medicare PIN
CAE24918Medicare UPIN