Organization
LAKE DERMATOLOGY MEDICAL ASSOC INC
Active
Other names
James R Kahn MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ROGER KAHN MD (PRESIDENT)
(707) 263-8955
Entity
Organization
Contact information
Practice address
5144 HILL RD E, LAKEPORT, CA 95453-6300
(707) 263-8955
(707) 263-8340
Mailing address
5144 HILL RD E, LAKEPORT, CA 95453-6300
(707) 263-8955
(707) 263-8340
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G058941
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G589410
—
CA
01
—
ZZZ05922Z
BLUE SHIELD
CA
Enumeration date
10/02/2007
Last updated
10/02/2007
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