Provider Demographics
NPI:1750423612
Name:KAN, CURTIS (OD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:KAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 LAS TUNAS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8410
Mailing Address - Country:US
Mailing Address - Phone:626-445-8770
Mailing Address - Fax:
Practice Address - Street 1:556 LAS TUNAS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8410
Practice Address - Country:US
Practice Address - Phone:626-445-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP7640T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0076401Medicaid
CAOP7640Medicare ID - Type Unspecified
CASD0076401Medicaid