Provider Demographics
NPI:1689023202
Name:KAHN, MATTHEW
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY AT STONY BROOK HOSPITAL DENTISTRY
Mailing Address - Street 2:151 WESTCHESTER HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SUNY AT STONY BROOK HOSPITAL DENTISTRY
Practice Address - Street 2:151 WESTCHESTER HALL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8711
Practice Address - Country:US
Practice Address - Phone:631-444-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program