Provider Demographics
NPI:1851541684
Name:KONISHI, CARLOS YOSHIYUKI (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:YOSHIYUKI
Last Name:KONISHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:YOSHIYUKI
Other - Last Name:KONISHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1120 W LA VETA AVE STE 660
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4244
Mailing Address - Country:US
Mailing Address - Phone:714-509-8481
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE STE 660&470
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:714-509-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist