Provider Demographics
NPI:1689975435
Name:MICHAEL E KAN MD
Entity Type:Organization
Organization Name:MICHAEL E KAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-378-2900
Mailing Address - Street 1:360 DARDANELLI LN STE 1G
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2900
Mailing Address - Fax:408-378-2039
Practice Address - Street 1:360 DARDANELLI LN STE 1G
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2900
Practice Address - Fax:408-378-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G53368Medicare UPIN