Provider Demographics
NPI:1255508677
Name:PORTER, KIM BROWN (PSYD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:BROWN
Last Name:PORTER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:2325 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3325
Practice Address - Country:US
Practice Address - Phone:213-428-1351
Practice Address - Fax:310-782-3461
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner