Provider Demographics
NPI:1528008430
Name:KAHN, LISA (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34841
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-0841
Mailing Address - Country:US
Mailing Address - Phone:310-280-9670
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:3834 HUGHES AVE
Practice Address - Street 2:#506
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2716
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11207103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY112070Medicaid
CAR14951Medicare UPIN
CAPSY112070Medicaid