Healthcare Provider Details

I. General information

NPI: 1184561268
Provider Name (Legal Business Name): KIMBERLY LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 REMICK AVE
ARLETA CA
91331-4223
US

IV. Provider business mailing address

10660 WHITE OAK AVE STE B101
GRANADA HILLS CA
91344-5943
US

V. Phone/Fax

Practice location:
  • Phone: 818-834-5805
  • Fax:
Mailing address:
  • Phone: 818-834-5805
  • Fax: 818-834-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240181416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: