Provider Demographics
NPI:1013323971
Name:DOM, KANHCHANA
Entity Type:Individual
Prefix:MS
First Name:KANHCHANA
Middle Name:
Last Name:DOM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KANH
Other - Middle Name:CHANA
Other - Last Name:DOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3512
Mailing Address - Country:US
Mailing Address - Phone:323-866-1880
Mailing Address - Fax:323-866-1881
Practice Address - Street 1:4221 WILSHIRE BLVD
Practice Address - Street 2:SUITE 300A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3512
Practice Address - Country:US
Practice Address - Phone:323-866-1880
Practice Address - Fax:323-866-1881
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst