MEDICARE: KAUSHANSKY PSYCHOLOGY, APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1467093591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAUSHANSKY PSYCHOLOGY, APC

Provider Business Mailing Address
First Line	:	PO BOX 491039
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-9039
Country	:	US
Telephone Number	:	310-498-5224
Fax Number	:

Provider Business Practice Location Address
First Line	:	10850 WILSHIRE BLVD STE 850
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4608
Country	:	US
Telephone Number	:	310-498-5224
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. DANIEL KAUSHANSKY
Credential	:	PSYD
Telephone Number	:	310-498-5224

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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