Provider Demographics
NPI:1750743530
Name:KAHANOWITCH, CHELSEY COLLEEN (DO)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:COLLEEN
Last Name:KAHANOWITCH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 TOWNSGATE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2433
Mailing Address - Country:US
Mailing Address - Phone:805-601-5051
Mailing Address - Fax:805-790-9303
Practice Address - Street 1:2239 TOWNSGATE RD STE 208
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2433
Practice Address - Country:US
Practice Address - Phone:805-601-5051
Practice Address - Fax:805-790-9303
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty