Provider Demographics
NPI:1770329054
Name:KITABAYASHI, KRISTYN HIROKO
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:HIROKO
Last Name:KITABAYASHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 KENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1262
Mailing Address - Country:US
Mailing Address - Phone:213-910-7944
Mailing Address - Fax:
Practice Address - Street 1:6930 KENTWOOD CT
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1262
Practice Address - Country:US
Practice Address - Phone:213-910-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5221224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant