Active NPI
Kenneth Steven Gordon, PHD
- Psychologist
- Westlake Village, CA
National Provider Identifier
1225529043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1525
- Practice address
- 755 Lakefield Rd Ste J
Westlake Village, CA 91361-2639 - Phone
- (805) 491-2478
- NPI assigned
- May 29, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4749-PY-PY | MA | |
| Psychologist | 103T00000X | 1525 | AZ | Primary |
Addresses
Primary practice location
755 Lakefield Rd Ste J
Westlake Village, CA 91361-2639
Mailing address
2650 Buggy LN
Santa Rosa Valley, CA 93012-9209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4749-PY-PY | MA | MD | Psychologist |
| 1525 | AZ | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527552000000",
"number": "1225529043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 BUGGY LN",
"city": "SANTA ROSA VALLEY",
"state": "CA",
"postal_code": "930129209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 LAKEFIELD RD STE J",
"city": "WESTLAKE VILLAGE",
"state": "CA",
"postal_code": "913612639",
"telephone_number": "805-491-2478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KENNETH",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-29",
"last_updated": "2018-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4749-PY-PY",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "1525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westlake Village, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.