Provider Demographics
NPI:1174564751
Name:KAHN, MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SEA PINES LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-9363
Mailing Address - Country:US
Mailing Address - Phone:360-797-5187
Mailing Address - Fax:
Practice Address - Street 1:113 SEA PINES LN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-9363
Practice Address - Country:US
Practice Address - Phone:360-797-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131709207R00000X
WAMD0004637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8465494Medicaid
NYC07861Medicare UPIN
NY206SJ1Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WAG8861243Medicare PIN