Provider Demographics
NPI:1679623706
Name:KATTENHORN, DAVID L (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KATTENHORN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E FOOTHILL BLVD
Mailing Address - Street 2:#204
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-446-8544
Mailing Address - Fax:626-446-1877
Practice Address - Street 1:50 E FOOTHILL BLVD
Practice Address - Street 2:#204
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-446-8544
Practice Address - Fax:626-446-1877
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R62331Medicare UPIN
CP8645Medicare ID - Type Unspecified