Provider Demographics
NPI:1700931474
Name:CHARLES KAHN AND WAYNE RISKIN M D S P A
Entity Type:Organization
Organization Name:CHARLES KAHN AND WAYNE RISKIN M D S P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-963-3791
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-963-3791
Mailing Address - Fax:954-964-6168
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-963-3791
Practice Address - Fax:954-964-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99423Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER