Healthcare Provider Details

I. General information

NPI: 1649121294
Provider Name (Legal Business Name): FAMILY TREE THERAPY & PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10660 WILSHIRE BLVD # 1103
LOS ANGELES CA
90024
US

IV. Provider business mailing address

10660 WILSHIRE BLVD # 1103
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-999-8388
  • Fax: 786-581-7706
Mailing address:
  • Phone: 310-999-8388
  • Fax: 786-581-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IDEEN A. KIAFAR
Title or Position: CEO
Credential: DO, MS
Phone: 310-999-8388