KGN Psychological Services, Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

28523 Issued in CA

Legal business name

KGN PSYCHOLOGICAL SERVICES, INC.

Doing business as

Kelly Granger Nguyen, Psy.D.

Practice address

222 W Main St
#101
Tustin, CA 92780-7720

Phone

(949) 381-1519

NPI assigned

Sep 10, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Marie Granger, PSY.D.

Title

President/Secretary

Phone

(949) 381-1519

Specialties & licenses 1

Addresses

Other names 1

• Kelly Granger Nguyen, Psy.D. Doing business as

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

{
    "created_epoch": "1473465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473465600000",
    "number": "1528515236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W MAIN ST",
            "address_2": "#101",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807720",
            "telephone_number": "949-381-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W MAIN ST",
            "address_2": "#101",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807720",
            "telephone_number": "949-381-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KGN PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-10",
        "last_updated": "2016-09-10",
        "status": "A",
        "authorized_official_last_name": "GRANGER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT/SECRETARY",
        "authorized_official_telephone_number": "949-381-1519",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "28523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly Granger Nguyen, Psy.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychologist in Tustin, CA
• Providers in Tustin, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2016; 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.