1730224791 NPI number — MS. CANDACE J PETERSON-KAHN MFT

Table of content: MS. CANDACE J PETERSON-KAHN MFT (NPI 1730224791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730224791 NPI number — MS. CANDACE J PETERSON-KAHN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON-KAHN
Provider First Name:
CANDACE
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSON
Provider Other First Name:
CANDACE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730224791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3851
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-787-1500
Provider Business Mailing Address Fax Number:
310-787-9713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE E100
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-787-1500
Provider Business Practice Location Address Fax Number:
310-787-9713
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC42724 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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