Provider Demographics
NPI:1093892572
Name:WORKENEH-MARTIN, LISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISHAN
Middle Name:
Last Name:WORKENEH-MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISHAN
Other - Middle Name:T
Other - Last Name:WORKENEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2081 PALOS VERDES DR N
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3701
Mailing Address - Country:US
Mailing Address - Phone:310-325-6542
Mailing Address - Fax:310-517-3499
Practice Address - Street 1:2081 PALOS VERDES DR N
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3701
Practice Address - Country:US
Practice Address - Phone:310-325-6542
Practice Address - Fax:310-517-3499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA760722084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry