Provider Demographics
NPI:1578579488
Name:KAHN, STEVEN (DDS, OMS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:DDS, OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE #1823
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-269-0100
Mailing Address - Fax:312-269-0004
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE #1823
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-269-0100
Practice Address - Fax:312-269-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0138501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37501Medicare UPIN
IL653570Medicare ID - Type Unspecified