Provider Demographics
NPI:1952525602
Name:KAREN E DYMOND PHD INC
Entity Type:Organization
Organization Name:KAREN E DYMOND PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:714-447-8782
Mailing Address - Street 1:1480 SOUTH HARBOR BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7534
Mailing Address - Country:US
Mailing Address - Phone:714-447-8782
Mailing Address - Fax:714-447-9386
Practice Address - Street 1:1480 S HARBOR BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7534
Practice Address - Country:US
Practice Address - Phone:714-447-8782
Practice Address - Fax:714-447-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16671OtherMEDICARE ID