Healthcare Provider Details

I. General information

NPI: 1376272344
Provider Name (Legal Business Name): KEVIN SIMONSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 WILSHIRE BLVD STE 211
SANTA MONICA CA
90403-2337
US

IV. Provider business mailing address

17800 WOODRUFF AVE STE B
BELLFLOWER CA
90706-7080
US

V. Phone/Fax

Practice location:
  • Phone: 323-283-9998
  • Fax: 434-204-5689
Mailing address:
  • Phone: 949-230-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SIMONSON
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 949-230-2291