Provider Demographics
NPI:1578502704
Name:KAHN, HENRY JAY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:JAY
Last Name:KAHN
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 1:500 PARNASSUS AVE
Mailing Address - Street 2:MUH 005 BOX 0722
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2203
Mailing Address - Country:US
Mailing Address - Phone:415-476-1683
Mailing Address - Fax:415-476-1683
Practice Address - Street 1:500 PARNASSUS AVE
Practice Address - Street 2:MUH-005 BOX 0722
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0722
Practice Address - Country:US
Practice Address - Phone:415-476-1683
Practice Address - Fax:415-476-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG032905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45339Medicare UPIN