Provider Demographics
NPI:1477089589
Name:INDOREWALLA, KHUSHNOO KERSOO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KHUSHNOO
Middle Name:KERSOO
Last Name:INDOREWALLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 OXNARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7108
Mailing Address - Country:US
Mailing Address - Phone:855-701-7955
Mailing Address - Fax:
Practice Address - Street 1:21550 OXNARD ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7108
Practice Address - Country:US
Practice Address - Phone:855-701-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty