Healthcare Provider Details

I. General information

NPI: 1326278540
Provider Name (Legal Business Name): ALEXIS KANT YETWIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS JOY KANT

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-8861
  • Fax:
Mailing address:
  • Phone: 323-361-8861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: