Provider Demographics
NPI:1477752038
Name:KAHNG, JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:KAHNG
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 1:1301 20TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2096
Mailing Address - Country:US
Mailing Address - Phone:310-453-0419
Mailing Address - Fax:310-829-1960
Practice Address - Street 1:1301 20TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2096
Practice Address - Country:US
Practice Address - Phone:310-453-0419
Practice Address - Fax:310-829-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH16790Medicare UPIN