Provider Demographics
NPI:1992973135
Name:KAHN, ANDREA SUE (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:KAHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUE
Other - Last Name:KAHN WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:116 NO ROBERTSON BLVD
Mailing Address - Street 2:SUITE 901
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3112
Mailing Address - Country:US
Mailing Address - Phone:310-855-1251
Mailing Address - Fax:310-854-3084
Practice Address - Street 1:116 NO ROBERTSON BLVD
Practice Address - Street 2:SUITE 901
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3112
Practice Address - Country:US
Practice Address - Phone:310-855-1251
Practice Address - Fax:310-854-3084
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical