Healthcare Provider Details

I. General information

NPI: 1972394831
Provider Name (Legal Business Name): KAGAN PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 BRIGHTON WAY STE 416
BEVERLY HILLS CA
90210-5120
US

IV. Provider business mailing address

9615 BRIGHTON WAY STE 416
BEVERLY HILLS CA
90210-5120
US

V. Phone/Fax

Practice location:
  • Phone: 310-800-1680
  • Fax: 747-200-6488
Mailing address:
  • Phone: 310-800-1680
  • Fax: 747-200-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW DAVID KAGAN
Title or Position: OWNER
Credential: MD
Phone: 310-800-1680