Provider Demographics
NPI:1700182805
Name:KEHDY LAI, HIBA
Entity type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:KEHDY LAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77564 COUNTRY CLUB DR STE 368
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6226
Mailing Address - Country:US
Mailing Address - Phone:760-449-7886
Mailing Address - Fax:760-636-1299
Practice Address - Street 1:77564 COUNTRY CLUB DR STE 368
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6226
Practice Address - Country:US
Practice Address - Phone:760-449-7886
Practice Address - Fax:760-636-1299
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist