Provider Demographics
NPI:1013921279
Name:KANTOR, ALAN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BERNARD
Last Name:KANTOR
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 1:960 N SAN ANTONIO RD UNIT 234
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1348
Mailing Address - Country:US
Mailing Address - Phone:146-295-1589
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE BLDG 5
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB87556Medicare UPIN
NYA300099441Medicare PIN