Provider Demographics
NPI:1275705550
Name:DENNIS, KIMBERLY LOUISE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 W 78TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4908
Mailing Address - Country:US
Mailing Address - Phone:323-759-7860
Mailing Address - Fax:
Practice Address - Street 1:2500 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4310
Practice Address - Country:US
Practice Address - Phone:213-639-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health