MEDICARE: DR. KIMBERLY A TELESH PH.D.

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	103TC0700X	Clinical Psychologist	PSY 21724	CA

General Provider Information

NPI Number	:	1942335336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY A TELESH PH.D.

Provider Business Mailing Address
First Line	:	3580 WILSHIRE BLVD
Second Line	:	SUITE 2000
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2501
Country	:	US
Telephone Number	:	213-381-1250
Fax Number	:	213-383-4803

Provider Business Practice Location Address
First Line	:	3580 WILSHIRE BLVD
Second Line	:	SUITE 2000
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2501
Country	:	US
Telephone Number	:	213-381-1250
Fax Number	:	213-383-4803

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	05/16/2008

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