Provider Demographics
NPI:1629029996
Name:ANDERSON, KATHLEEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:23501 PARK SORRENTO
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1308
Mailing Address - Country:US
Mailing Address - Phone:818-222-7871
Mailing Address - Fax:818-222-7894
Practice Address - Street 1:23501 PARK SORRENTO
Practice Address - Street 2:SUITE 210
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1308
Practice Address - Country:US
Practice Address - Phone:818-222-7871
Practice Address - Fax:818-222-7894
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-09-13
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Provider Licenses
StateLicense IDTaxonomies
CAG58593207Q00000X
CAG35393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53423Medicare UPIN