1588943682 NPI number — SOUTHERN CALIFORNIA GLAUCOMA CONSULTANTS MEDICAL GROUP

Table of content: DAVID BEECHER KAHN M.D. (NPI 1568488344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588943682 NPI number — SOUTHERN CALIFORNIA GLAUCOMA CONSULTANTS MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CALIFORNIA GLAUCOMA CONSULTANTS MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588943682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 S RAYMOND AVE
Provider Second Line Business Mailing Address:
230
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-577-1115
Provider Business Mailing Address Fax Number:
626-577-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S RAYMOND AVE
Provider Second Line Business Practice Location Address:
230
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-577-1115
Provider Business Practice Location Address Fax Number:
626-577-1385
Provider Enumeration Date:
08/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SOLISH
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
OWNER/ MEDICAL DIRECTOR
Authorized Official Telephone Number:
626-577-1115

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G42828 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com