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General NPI Number Information
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NPI Number | 1164016978
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Entity Type | Individual
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Provider Name | KHRISHUNDA UPSHAW TRICHOLOGIST/HHP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 2700 TEMPLE AVE STE D
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City | LONG BEACH
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State | CA
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Zip | 90806-2280
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Country | US
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Telephone | 310-754-5297
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 GARONA DR
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6647
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Country | US
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Telephone | 310-754-5297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 228944003
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 228944003
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 228944003
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License Number State | CA
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