Provider Demographics
NPI:1912266248
Name:KAHEN, SIMONE BROOKHIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:BROOKHIM
Last Name:KAHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:BROOKHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10 CUTTERMILL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3258
Mailing Address - Country:US
Mailing Address - Phone:516-603-8824
Mailing Address - Fax:
Practice Address - Street 1:10 CUTTERMILL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3258
Practice Address - Country:US
Practice Address - Phone:516-603-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice