Provider Demographics
NPI:1275687014
Name:KAGAN, ANNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:KAGAN
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 1:5455 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1714
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4217
Mailing Address - Country:US
Mailing Address - Phone:323-936-7755
Mailing Address - Fax:323-936-6644
Practice Address - Street 1:5455 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1714
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4217
Practice Address - Country:US
Practice Address - Phone:323-936-7755
Practice Address - Fax:323-936-6644
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA427552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A427550Medicaid
CA00A427550Medicaid
C35545Medicare UPIN