Provider Demographics
NPI:1598937302
Name:TANAZ KAHEN MD, INC
Entity Type:Organization
Organization Name:TANAZ KAHEN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TANAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-344-8822
Mailing Address - Street 1:5525 ETIWANDA AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6117
Mailing Address - Country:US
Mailing Address - Phone:818-344-8822
Mailing Address - Fax:818-344-3587
Practice Address - Street 1:5525 ETIWANDA AVE STE 209
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6117
Practice Address - Country:US
Practice Address - Phone:818-344-8822
Practice Address - Fax:818-344-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793360OtherBLUE SHIELD PROVIDER NUMB
CA00A793360Medicaid
WA79336BOtherMEDI CARE PROVIDER NUMBER
CA1679542898OtherTYPE ONE NPI
CAA79336OtherPROVIDER COMERCIAL NUMBER
CA00A793360OtherBLUE CROSS PROVIDER NUMBE
CAA79336OtherSTATE LICENSE NUMBER
CA00A793360Medicaid
CAA79336OtherPROVIDER COMERCIAL NUMBER