Provider Demographics
NPI:1538455860
Name:MARK T KAN, INC
Entity type:Organization
Organization Name:MARK T KAN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-222-1290
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-222-1290
Mailing Address - Fax:949-222-1289
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-222-1290
Practice Address - Fax:949-222-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82378207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty