Provider Demographics
NPI:1477163004
Name:HOSSEPIAN, DERIK (PSYD)
Entity type:Individual
Prefix:DR
First Name:DERIK
Middle Name:
Last Name:HOSSEPIAN
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 1:4605 LANKERSHIM BLVD
Mailing Address - Street 2:STE 545
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602
Mailing Address - Country:US
Mailing Address - Phone:323-999-1395
Mailing Address - Fax:855-568-6438
Practice Address - Street 1:4605 LANKERSHIM BLVD
Practice Address - Street 2:STE 545
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602
Practice Address - Country:US
Practice Address - Phone:323-999-1395
Practice Address - Fax:855-568-6438
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34310103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist