Provider Demographics
NPI:1720013907
Name:KAHN, MYRA JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:JOYCE
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1949
Mailing Address - Country:US
Mailing Address - Phone:818-947-4026
Mailing Address - Fax:
Practice Address - Street 1:7515 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91605-1949
Practice Address - Country:US
Practice Address - Phone:818-947-4026
Practice Address - Fax:818-949-8850
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90330Medicare UPIN