Basic Information
| Provider Information | |||||||||
| NPI: | 1447338926 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KAN | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 W BONITA AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917732543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595853937 | ||||||||
| FaxNumber: | 5595823645 | ||||||||
| Practice Location | |||||||||
| Address1: | 377 E CHAPMAN AVE | ||||||||
| Address2: | STE 240 | ||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928705091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145722039 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 1433 | SC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | OP60291650 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 20A9163 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.