Provider Demographics
NPI:1063555209
Name:CHINARIAN, KELLY ANN (MS)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ANN
Last Name:CHINARIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 COLORADO AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5053
Mailing Address - Country:US
Mailing Address - Phone:562-445-8177
Mailing Address - Fax:
Practice Address - Street 1:16415 COLORADO AVE STE 305
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5053
Practice Address - Country:US
Practice Address - Phone:562-445-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49895106H00000X
CAIMF50378225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist