Provider Demographics
NPI:1629313143
Name:KAN, CHRISTINE (OTD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 HOPE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2650
Mailing Address - Country:US
Mailing Address - Phone:626-344-7505
Mailing Address - Fax:
Practice Address - Street 1:1605 HOPE ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2650
Practice Address - Country:US
Practice Address - Phone:626-344-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-303637174N00000X
CAOT13133225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174N00000XOther Service ProvidersLactation Consultant, Non-RN