Provider Demographics
NPI:1245364991
Name:KAGAN, FAY READ (MD)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:READ
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12450 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1391
Mailing Address - Country:US
Mailing Address - Phone:818-896-8366
Mailing Address - Fax:818-896-8392
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-8366
Practice Address - Fax:818-896-8392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG567622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00CV116OtherEMPLOYEE ID