MEDICARE: RICHARD CHANNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750968012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHANNA

Provider Business Mailing Address
First Line	:	18726 S WESTERN AVE STE 408
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3858
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 N MAIN ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-6639
Country	:	US
Telephone Number	:	949-357-2556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	04/15/2026

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Directions to “ RICHARD CHANNA ” Practice Location

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