Provider Demographics
NPI:1194778043
Name:KANTAN PLLC
Entity type:Organization
Organization Name:KANTAN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-926-5518
Mailing Address - Street 1:1005 N PINES RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4986
Mailing Address - Country:US
Mailing Address - Phone:509-926-5518
Mailing Address - Fax:509-922-9892
Practice Address - Street 1:1005 N PINES RD STE 110
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4958
Practice Address - Country:US
Practice Address - Phone:509-926-5518
Practice Address - Fax:509-922-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 774213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00210998OtherRR GROUP #
WA1121722OtherDSHS
WAG8851865Medicare PIN
WA1121722OtherDSHS
WA5410700001Medicare NSC
WAP00210998OtherRR GROUP #