Provider Demographics
NPI:1427276039
Name:KURGAN, LEONIA U (LEONIA KURGAN MFT)
Entity type:Individual
Prefix:DR
First Name:LEONIA
Middle Name:U
Last Name:KURGAN
Suffix:
Gender:F
Credentials:LEONIA KURGAN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S SALTAIR AVE
Mailing Address - Street 2:#102,
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1325
Mailing Address - Country:US
Mailing Address - Phone:310-478-9417
Mailing Address - Fax:
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:#201,
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-453-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMH16956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA560-57-2975B6Medicare ID - Type Unspecified