Provider Demographics
NPI:1528795945
Name:KAN, SUZANNE (DDS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 SAWTELLE BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1441
Mailing Address - Country:US
Mailing Address - Phone:808-600-1908
Mailing Address - Fax:
Practice Address - Street 1:3140 SAWTELLE BLVD APT 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1441
Practice Address - Country:US
Practice Address - Phone:808-600-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-3188-01223P0221X
CA1084791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry