Individual
CHAD KIYOSHI EBESUTANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 VETERAN AVE, LOS ANGELES, CA 90024-2704
(310) 825-3301
Mailing address
PO BOX 951563, LOS ANGELES, CA 90095-1563
(310) 825-3301
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
H00715964
HI
Other
Enumeration date
09/11/2008
Last updated
10/02/2009
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