Blair Kilpatrick-Tabak, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15604 Issued in CA

Practice address

3100 Mowry Ave
Ste 410
Fremont, CA 94538-1509

Phone

(510) 791-1036

Fax

(510) 791-1036

NPI assigned

Feb 15, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Blair Kilpatrick Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114060282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 ADA ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031001",
            "telephone_number": "510-526-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MOWRY AVE",
            "address_2": "STE 410",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381509",
            "telephone_number": "510-791-1036",
            "fax_number": "510-791-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILPATRICK-TABAK",
        "first_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLAIR",
            "last_name": "KILPATRICK",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Megan Kiefert
• Hiroyasu Kikawa, M.D.
• Prasad G Kilaru
• Dorothy Perez Killian, A.U.
• Courtney Nicole Killion
• Kim Hoang, DDS Dental Corporation
• Amalia Kim, PPS
• Bonnie Y Kim, MD
• Charles Kim, DDS
• Clifford Intaik Kim, M.D.

• Clinical Psychologist in Fremont, CA
• Providers in Fremont, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.