Healthcare Provider Details

I. General information

NPI: 1396024261
Provider Name (Legal Business Name): KIMBERLY ANNE HEPNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 MAIN ST
SANTA MONICA CA
90401-3208
US

IV. Provider business mailing address

1776 MAIN ST
SANTA MONICA CA
90401-3208
US

V. Phone/Fax

Practice location:
  • Phone: 310-393-0411
  • Fax: 310-451-7066
Mailing address:
  • Phone: 310-393-0411
  • Fax: 310-451-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: