Provider Demographics
NPI:1699193649
Name:KAHN, EUGENE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:THOMAS
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 REAGAN ST
Mailing Address - Street 2:#97
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-1689
Mailing Address - Country:US
Mailing Address - Phone:657-224-9209
Mailing Address - Fax:657-224-9304
Practice Address - Street 1:3801 KATELLA AVE STE 320
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3344
Practice Address - Country:US
Practice Address - Phone:657-224-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA149600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery