=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114284023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL SHULMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2012
-----------------------------------------------------
Last Update Date | 11/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 N EDGEMONT ST FL 3
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-783-8206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 W SUNSET BLVD KAISER PERMANENTE ADDICTION MEDICINE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-783-8206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 86689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------