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General NPI Number Information
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NPI Number | 1811444599
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Entity Type | Individual
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Provider Name | DR. SAMANTHA KUCAJ
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Gender | Female
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 300 UCLA MEDICAL PLZ STE 3300
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City | LOS ANGELES
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State | CA
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Zip | 90095-6062
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Country | US
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Telephone | 323-825-0867
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Fax | 310-206-4215
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-301-8807
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Fax | 310-301-8751
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY30599
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License Number State | CA
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