Provider Demographics
NPI:1245241934
Name:KAHN, JEFFERY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOTT
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 1:3838 WATT AVE
Mailing Address - Street 2:STE F605
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2665
Mailing Address - Country:US
Mailing Address - Phone:916-481-4413
Mailing Address - Fax:916-487-6858
Practice Address - Street 1:1317 H ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1945
Practice Address - Country:US
Practice Address - Phone:916-501-6088
Practice Address - Fax:916-386-3097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA697722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697720OtherMEDI CAL
00A697720Medicare ID - Type Unspecified
H88397Medicare UPIN