Individual
KENNY A KARYADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11835 W OLYMPIC BLVD STE 1265E, LOS ANGELES, CA 90064-5814
(310) 273-4843
(310) 273-5056
Mailing address
268 W HOSPITALITY LN, STE 300, SAN BERNARDINO, CA 92408-3241
(909) 651-4518
(909) 651-4586
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY29812
CA
Other
Enumeration date
03/22/2018
Last updated
12/03/2021
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