Provider Demographics
NPI:1609477454
Name:SAITO, ELIZABETH KIM
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KIM
Last Name:SAITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KIM
Other - Last Name:SAITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4470 W SUNSET BLVD
Mailing Address - Street 2:STE 107, PMB 95818
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6309
Mailing Address - Country:US
Mailing Address - Phone:310-729-6129
Mailing Address - Fax:
Practice Address - Street 1:4470 W SUNSET BLVD
Practice Address - Street 2:STE 107, PMB 95818
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6309
Practice Address - Country:US
Practice Address - Phone:310-729-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42973101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor