MEDICARE: DR. ROGER ALAN KLEINMAN PH.D.

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	103G00000X	Clinical Neuropsychologist	PSY6084	CA
2	103T00000X	Psychologist	PSY6084	CA
3	103TA0700X	Adult Development & Aging Psychologist	PSY6084	CA
4	103TB0200X	Cognitive & Behavioral Psychologist	PSY6084	CA
5	103TC0700X	Clinical Psychologist	PSY6084	CA
6	103TC2200X	Clinical Child & Adolescent Psychologist	PSY6084	CA
7	103TF0000X	Family Psychologist	PSY6084	CA
8	103TF0200X	Forensic Psychologist	PSY6084	CA
9	103TH0004X	Health Psychologist	PSY6084	CA
10	103TH0100X	Health Service Psychologist	PSY6084	CA
11	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY6084	CA
12	103TP2701X	Group Psychotherapy Psychologist	PSY6084	CA
13	103TR0400X	Rehabilitation Psychologist	PSY6084	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VALUE OPTIONS	OTHER	CA	176151
2	68-0493282	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1205046596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER ALAN KLEINMAN PH.D.

Provider Business Mailing Address
First Line	:	18811 HUNTINGTON ST
Second Line	:	SUITE 200
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6002
Country	:	US
Telephone Number	:	714-565-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	18811 HUNTINGTON ST
Second Line	:	SUITE 200
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6002
Country	:	US
Telephone Number	:	714-565-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	05/24/2026

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