Provider Demographics
NPI:1639278351
Name:THOMAS A KAHAN MD PC
Entity Type:Organization
Organization Name:THOMAS A KAHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-508-4283
Mailing Address - Street 1:8330 WHEATLAND RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3469
Mailing Address - Country:US
Mailing Address - Phone:503-508-4283
Mailing Address - Fax:503-371-0606
Practice Address - Street 1:8330 WHEATLAND RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3469
Practice Address - Country:US
Practice Address - Phone:503-508-4283
Practice Address - Fax:503-371-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11190261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022434Medicaid
135451Medicare PIN
C92996Medicare UPIN