MEDICARE: DR. KAY PSYCHOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1033938535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. KAY PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	21213 HAWTHORNE BLVD STE B
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-5522
Country	:	US
Telephone Number	:	424-237-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 MOTOR AVE STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5887
Country	:	US
Telephone Number	:	424-237-8811
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	KAY MIMAKI
Credential	:	PH.D.
Telephone Number	:	424-237-8811

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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