Provider Demographics
NPI:1447338926
Name:KAN, LEO H (DO)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:H
Last Name:KAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 W BONITA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2543
Mailing Address - Country:US
Mailing Address - Phone:559-585-3937
Mailing Address - Fax:559-582-3645
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:STE 240
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5091
Practice Address - Country:US
Practice Address - Phone:714-572-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1433207W00000X
WAOP60291650207W00000X
CA20A9163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74700Medicare UPIN