Provider Demographics
NPI:1073350369
Name:MAKKAR, KINSEY NABIHA NADIA
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:NABIHA NADIA
Last Name:MAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13157 MINDANAO WAY
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6307
Mailing Address - Country:US
Mailing Address - Phone:424-261-3070
Mailing Address - Fax:
Practice Address - Street 1:301 N PRAIRIE AVE STE 510
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4512
Practice Address - Country:US
Practice Address - Phone:310-258-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist