Provider Demographics
NPI:1558414623
Name:KAN, MICHAEL EDMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDMOND
Last Name:KAN
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 1:360 DARDANELLI LN
Mailing Address - Street 2:#1-G
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2900
Mailing Address - Fax:408-378-2039
Practice Address - Street 1:360 DARDANELLI LN
Practice Address - Street 2:#1-G
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2900
Practice Address - Fax:408-378-2039
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53368174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist