Provider Demographics
NPI:1255508677
Name:PORTER, KIM BROWN (PSYD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:BROWN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3325
Mailing Address - Country:US
Mailing Address - Phone:213-428-1351
Mailing Address - Fax:310-782-3461
Practice Address - Street 1:10421 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-4423
Practice Address - Country:US
Practice Address - Phone:323-418-4200
Practice Address - Fax:323-242-6857
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103T00000XBehavioral Health & Social Service ProvidersPsychologist