Provider Demographics
NPI:1972588622
Name:ZAHN, EVAN M (MD)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:M
Last Name:ZAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:127 S. SAN VICENTE BLVD
Mailing Address - Street 2:AHSP, A3600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-1153
Mailing Address - Fax:310-423-6795
Practice Address - Street 1:127 S. SAN VICENTE BLVD
Practice Address - Street 2:AHSP, A3600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-1153
Practice Address - Fax:310-423-6795
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG736742080P0202X, 207RI0011X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378532700Medicaid
FL378532700Medicaid
FL28361ZMedicare PIN