Healthcare Provider Details

I. General information

NPI: 1265127468
Provider Name (Legal Business Name): KENNETH DOWLING PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD PMB 252883
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 252883
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 650-773-0736
  • Fax: 650-773-0736
Mailing address:
  • Phone: 310-361-6847
  • Fax: 213-260-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36761
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number025778-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: