Provider Demographics
NPI:1851863187
Name:KANAN, IRAN
Entity Type:Individual
Prefix:
First Name:IRAN
Middle Name:
Last Name:KANAN
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 1:3070 BRISTOL PIKE
Mailing Address - Street 2:BUILDING 2, SUITE 214
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-939-7777
Mailing Address - Fax:
Practice Address - Street 1:2133 STEVENS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-3533
Practice Address - Country:US
Practice Address - Phone:215-939-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA38923601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
3892OtherMEDICARE