Provider Demographics
NPI:1609883115
Name:UNMACHT, KEN GEORGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:GEORGE
Last Name:UNMACHT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:G
Other - Last Name:UNMACHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:12381 WILSHIRE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1063
Mailing Address - Country:US
Mailing Address - Phone:310-207-1246
Mailing Address - Fax:310-207-0054
Practice Address - Street 1:12381 WILSHIRE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1063
Practice Address - Country:US
Practice Address - Phone:310-207-1246
Practice Address - Fax:310-207-0054
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM16673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist