1073694808 NPI number — EDWARD A KAHN DMD

Table of content: EDWARD A KAHN DMD (NPI 1073694808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073694808 NPI number — EDWARD A KAHN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHN
Provider First Name:
EDWARD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073694808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-7061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-321-6076
Provider Business Mailing Address Fax Number:
405-321-3830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-7061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-321-6076
Provider Business Practice Location Address Fax Number:
405-321-3830
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5691 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200088290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".