Provider Demographics
NPI:1366467730
Name:KANE, EDWARD W (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:KANE
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 1:2185 VIA DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2839
Mailing Address - Country:US
Mailing Address - Phone:760-525-6080
Mailing Address - Fax:
Practice Address - Street 1:2023 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-724-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22257207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G222570Medicaid
CAA90755Medicare UPIN
CAWG22257AMedicare PIN
CA00G222570Medicaid