Provider Demographics
NPI:1619958626
Name:KAHN, CLIFFORD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ROBERT
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLIFFORD
Other - Middle Name:
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17525 VENTURA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5109
Mailing Address - Country:US
Mailing Address - Phone:818-986-3366
Mailing Address - Fax:818-986-3866
Practice Address - Street 1:17525 VENTURA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5109
Practice Address - Country:US
Practice Address - Phone:818-986-3366
Practice Address - Fax:818-986-3866
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34659207X00000X, 207XX0004X
CA6268120001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G346590Medicaid
CAA91615Medicare UPIN
CA6268120001Medicare NSC
CAAY293ZMedicare PIN