Provider Demographics
NPI:1487820361
Name:KAHN,KAHN,KAHN
Entity Type:Organization
Organization Name:KAHN,KAHN,KAHN
Other - Org Name:KAHN,KAHN,KAHN & HLUDZINSKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TED
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-289-1555
Mailing Address - Street 1:1645 ROUTE 112
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3635
Mailing Address - Country:US
Mailing Address - Phone:631-289-1555
Mailing Address - Fax:
Practice Address - Street 1:1645 ROUTE 112
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3635
Practice Address - Country:US
Practice Address - Phone:631-289-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0353791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty