Provider Demographics
NPI:1891811857
Name:KILHEFNER, DONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:KILHEFNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 N STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4014
Mailing Address - Country:US
Mailing Address - Phone:323-874-8297
Mailing Address - Fax:
Practice Address - Street 1:1324 N STANLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4014
Practice Address - Country:US
Practice Address - Phone:323-874-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14266103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14266Medicare ID - Type UnspecifiedPROVIDER #