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General NPI Number Information
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NPI Number | 1649121294
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Entity Type | Organization
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Legal Business Name | FAMILY TREE THERAPY & PSYCHIATRY
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 10660 WILSHIRE BLVD # 1103
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-999-8388
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Fax | 786-581-7706
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Provider Business Mailing Address
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Address Line | 10660 WILSHIRE BLVD # 1103
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-999-8388
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Fax | 786-581-7706
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Authorized Official
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Title or Position | CEO
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Name | DR. IDEEN A. KIAFAR
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Credential | DO, MS
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Telephone | 310-999-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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