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General NPI Number Information
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NPI Number | 1245369990
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Entity Type | Individual
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Provider Name | KIMBERLY HAGEN HAGEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE TRAILER 6
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 310-668-6428
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CORPORATE POINTE SUITE 300
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City | CULVER CITY
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State | CA
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Zip | 90230-7615
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Country | US
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Telephone | 310-625-9256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 16798
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License Number State | CA
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