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General NPI Number Information
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NPI Number | 1992711980
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Entity Type | Individual
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Provider Name | DR. KENNETH ALAN BAUM
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5655 LINDERO CANYON RD STE 621
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4052
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Country | US
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Telephone | 805-497-1852
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Fax | 805-497-1852
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Provider Business Mailing Address
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Address Line | 2141 MONTROSE DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2436
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Country | US
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Telephone | 805-497-1852
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Fax | 805-497-1852
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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 | PSY8736
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License Number State | CA
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