Healthcare Provider Details

I. General information

NPI: 1992835342
Provider Name (Legal Business Name): KATHRYN S. UZUNOV PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 701
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

9201 W SUNSET BLVD SUITE 701
LOS ANGELES CA
90069-3701
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-0763
  • Fax: 714-893-3267
Mailing address:
  • Phone: 310-497-0763
  • Fax: 714-893-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: