Provider Demographics
NPI:1386168664
Name:SABZBALOUCH-I-BAM, KIMYA
Entity type:Individual
Prefix:
First Name:KIMYA
Middle Name:
Last Name:SABZBALOUCH-I-BAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 PETIT AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5627
Mailing Address - Country:US
Mailing Address - Phone:818-530-8969
Mailing Address - Fax:
Practice Address - Street 1:1819 CLIFF DR STE F
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1650
Practice Address - Country:US
Practice Address - Phone:805-586-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program