Provider Demographics
NPI:1639134794
Name:DAHHAN, ABDULKADER (MD)
Entity type:Individual
Prefix:
First Name:ABDULKADER
Middle Name:
Last Name:DAHHAN
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 1:120 PROFESSIONAL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2600
Mailing Address - Country:US
Mailing Address - Phone:606-573-1085
Mailing Address - Fax:
Practice Address - Street 1:120 PROFESSIONAL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2600
Practice Address - Country:US
Practice Address - Phone:606-573-1085
Practice Address - Fax:606-573-1085
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1420901Medicare PIN
C65543Medicare UPIN