Provider Demographics
NPI:1518148790
Name:KISHNER, DANIEL (HAD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:KISHNER
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1047
Mailing Address - Country:US
Mailing Address - Phone:310-488-7244
Mailing Address - Fax:
Practice Address - Street 1:1850 S WATERMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2877
Practice Address - Country:US
Practice Address - Phone:310-488-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7303237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518148790Medicaid