Provider Demographics
NPI:1568595056
Name:HARDIN, KIMERON NORMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMERON
Middle Name:NORMAN
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3507
Mailing Address - Country:US
Mailing Address - Phone:650-743-7922
Mailing Address - Fax:866-885-2864
Practice Address - Street 1:1053 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3507
Practice Address - Country:US
Practice Address - Phone:650-743-7922
Practice Address - Fax:866-885-2864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS05255Medicare UPIN
CAOPL143261Medicare PIN