Provider Demographics
NPI:1770640047
Name:PARISEAU, KIM TRUONG (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:TRUONG
Last Name:PARISEAU
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:28768 BEATTIE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5060
Mailing Address - Country:US
Mailing Address - Phone:909-534-0077
Mailing Address - Fax:714-245-1001
Practice Address - Street 1:960 W 17TH ST STE F
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3572
Practice Address - Country:US
Practice Address - Phone:714-852-7277
Practice Address - Fax:714-245-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical