Healthcare Provider Details

I. General information

NPI: 1629313143
Provider Name (Legal Business Name): CHRISTINE KAN OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 HOPE ST STE 200
SOUTH PASADENA CA
91030-2650
US

IV. Provider business mailing address

1605 HOPE ST STE 200
SOUTH PASADENA CA
91030-2650
US

V. Phone/Fax

Practice location:
  • Phone: 626-344-7505
  • Fax:
Mailing address:
  • Phone: 626-344-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-303637
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT13133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: