Provider Demographics
NPI:1578210225
Name:KIAN MENTAL HEALTH
Entity Type:Organization
Organization Name:KIAN MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUQAYYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-704-2470
Mailing Address - Street 1:27201 PUERTA REAL STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8590
Mailing Address - Country:US
Mailing Address - Phone:310-704-2470
Mailing Address - Fax:
Practice Address - Street 1:27201 PUERTA REAL STE 300
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8590
Practice Address - Country:US
Practice Address - Phone:310-704-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty