Provider Demographics
NPI:1790265395
Name:SANATI, KIMIA SHANNON
Entity Type:Individual
Prefix:
First Name:KIMIA
Middle Name:SHANNON
Last Name:SANATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21773 PLANEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5216
Mailing Address - Country:US
Mailing Address - Phone:818-322-5703
Mailing Address - Fax:
Practice Address - Street 1:977 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2919
Practice Address - Country:US
Practice Address - Phone:718-283-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician