Individual provider Active NPI

Glen Anthen Kan, DDS

  • Dentist
  • Silver Spring, MD
National Provider Identifier
1215044011
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10392 Issued in MD
Practice address
10801 Lockwood Drive
Ste 390
Silver Spring, MD 20901-1562
Phone
(301) 585-7766
Fax
(301) 585-7767
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10392 MD Primary

Addresses

Primary practice location

10801 Lockwood Drive
Ste 390
Silver Spring, MD 20901-1562

Mailing address

10801 Lockwood Drive
Ste 390
Silver Spring, MD 20901-1562
Phone (301) 585-7766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160119001251 MD Order and Referring Only - DentistPractitioner - Dentist 8820391220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10392MDMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215044011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 LOCKWOOD DRIVE",
            "address_2": "STE 390",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209011562",
            "telephone_number": "301-585-7766",
            "fax_number": "301-585-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 LOCKWOOD DRIVE",
            "address_2": "STE 390",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209011562",
            "telephone_number": "301-585-7766",
            "fax_number": "301-585-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAN",
        "first_name": "GLEN",
        "middle_name": "ANTHEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "10392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

Verify at the official NPI Registry.