Provider Demographics
NPI:1689629057
Name:KEDAN, ILAN (MD)
Entity type:Individual
Prefix:
First Name:ILAN
Middle Name:
Last Name:KEDAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N LA CIENEGA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2283
Mailing Address - Country:US
Mailing Address - Phone:310-307-5555
Mailing Address - Fax:424-249-3103
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2283
Practice Address - Country:US
Practice Address - Phone:310-307-5555
Practice Address - Fax:424-249-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93684174400000X, 207RI0011X
DCMD034206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035716400Medicaid
MD404855500Medicaid
CA1689629057OtherCARDIOLOGY
DC035716400Medicaid
VA010087511Medicare ID - Type Unspecified