Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013323971 |
---|---|
Provider Name | Ms. Kanhchana Dom |
First Address | Los Angeles, CA 90010-3512 |
Second Address | Los Angeles, CA 90010-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 17/04/2017 |