Provider Demographics
NPI:1871838367
Name:CAHN, JUSTIN FARRELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:FARRELL
Last Name:CAHN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:818-841-3936
Mailing Address - Fax:818-841-5974
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-841-3936
Practice Address - Fax:818-841-5974
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 22698OtherPHYSICIAN ASSISTANT ID
CAGW094YMedicare PIN
CACB246761Medicare PIN
CAGW094WMedicare PIN
CAGW094XMedicare PIN
CAGW094ZMedicare PIN
CACB207040Medicare PIN