Provider Demographics
NPI:1396823431
Name:KANTOR, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KANTOR
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 1:27875 SMYTH DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-6064
Mailing Address - Country:US
Mailing Address - Phone:661-259-2110
Mailing Address - Fax:661-259-2299
Practice Address - Street 1:27875 SMYTH DR STE 101
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-6064
Practice Address - Country:US
Practice Address - Phone:661-259-2110
Practice Address - Fax:661-259-2299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69250207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A69250Medicare ID - Type Unspecified
G98687Medicare UPIN