MEDICARE: FAMILY TREE THERAPY & PSYCHIATRY

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	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1649121294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TREE THERAPY & PSYCHIATRY

Provider Business Mailing Address
First Line	:	10660 WILSHIRE BLVD # 1103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-999-8388
Fax Number	:	786-581-7706

Provider Business Practice Location Address
First Line	:	10660 WILSHIRE BLVD # 1103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-999-8388
Fax Number	:	786-581-7706

Authorized Official
Title or Position	:	CEO
Name	:	DR. IDEEN A. KIAFAR
Credential	:	DO, MS
Telephone Number	:	310-999-8388

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “FAMILY TREE THERAPY & PSYCHIATRY ” Practice Location

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