Provider Demographics
NPI:1790839538
Name:KAGAN, ARKADY BENJAMINE (MD)
Entity Type:Individual
Prefix:MR
First Name:ARKADY
Middle Name:BENJAMINE
Last Name:KAGAN
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 1:5455 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1714
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4217
Mailing Address - Country:US
Mailing Address - Phone:323-937-2269
Mailing Address - Fax:323-936-6640
Practice Address - Street 1:5455 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1714
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4217
Practice Address - Country:US
Practice Address - Phone:323-937-2269
Practice Address - Fax:323-936-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76135207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G761350Medicaid
CAG76135Medicare ID - Type Unspecified
F41176Medicare UPIN