Provider Demographics
NPI:1245043629
Name:KAHN, TRISTAN LEIGH
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:LEIGH
Last Name:KAHN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 E NAGANO DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4302
Mailing Address - Country:US
Mailing Address - Phone:505-946-8649
Mailing Address - Fax:
Practice Address - Street 1:1526 E MEDICAL CENTER DR.
Practice Address - Street 2:#224A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:505-946-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program