Basic Information
Provider Information
NPI: 1336678093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAHAN
FirstName: JOSEPH
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4601 PARK RD STE 300
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282092290
CountryCode: US
TelephoneNumber: 7043232248
FaxNumber:  
Practice Location
Address1: 1915 RANDOLPH RD
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282071101
CountryCode: US
TelephoneNumber: 7043233003
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2017
LastUpdateDate: 08/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207X00000X2022-02073NCY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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