Provider Demographics
NPI:1013075829
Name:KAHN, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
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 1:450 SKOKIE BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7913
Mailing Address - Country:US
Mailing Address - Phone:847-509-8732
Mailing Address - Fax:847-586-0242
Practice Address - Street 1:450 SKOKIE BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7913
Practice Address - Country:US
Practice Address - Phone:847-509-8732
Practice Address - Fax:847-586-0242
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL0360820842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51702Medicare UPIN
247910Medicare ID - Type Unspecified