Basic Information
| Provider Information | |||||||||
| NPI: | 1699933556 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDRAM KAHEN, DPM INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEGACY CENTERS FOR FOOT AND ANKLE SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5140 WHITE OAK AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913162466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186369559 | ||||||||
| FaxNumber: | 4136399559 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 STANYAN STREET | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156681000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | KAHEN | ||||||||
| AuthorizedOfficialFirstName: | PEDRAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8186369559 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | E4774 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.