Provider Demographics
NPI:1194937524
Name:KAN, KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GUENETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1996 SARANAC AVE
Mailing Address - Street 2:STE. 2
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1140
Mailing Address - Country:US
Mailing Address - Phone:518-523-8882
Mailing Address - Fax:
Practice Address - Street 1:1996 SARANAC AVE
Practice Address - Street 2:STE. 2
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1140
Practice Address - Country:US
Practice Address - Phone:518-523-8882
Practice Address - Fax:518-837-5261
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF96795Medicare UPIN