Provider Demographics
NPI:1912915901
Name:KAHN-ROSE, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:KAHN-ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:P
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:# 1205
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4362
Mailing Address - Country:US
Mailing Address - Phone:818-385-1219
Mailing Address - Fax:818-385-1600
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:# 1205
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4362
Practice Address - Country:US
Practice Address - Phone:818-385-1219
Practice Address - Fax:818-385-1600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG597912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAES238ZMedicare PIN