Provider Demographics
NPI:1063706422
Name:MICHAEL E. KAN FAMILY PRACTICE
Entity type:Organization
Organization Name:MICHAEL E. KAN FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-378-2900
Mailing Address - Street 1:360 DARDANELLI LN
Mailing Address - Street 2:SUITE 1-G
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2900
Mailing Address - Fax:
Practice Address - Street 1:360 DARDANELLI LN
Practice Address - Street 2:SUITE 1-G
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty