Michael Dennis Kogutek, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY5975 Issued in CA

Practice address

17291 Irvine Blvd Ste 200
Tustin, CA 92780-2930

Phone

(714) 973-7621

Fax

(714) 368-3302

NPI assigned

Jul 18, 2006

Sex

Male

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

• Michael Dennis Kogutek Professional 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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770502247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17291 IRVINE BLVD STE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802930",
            "telephone_number": "714-973-7621",
            "fax_number": "714-368-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17291 IRVINE BLVD STE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802930",
            "telephone_number": "714-973-7621",
            "fax_number": "714-368-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOGUTEK",
        "first_name": "MICHAEL",
        "middle_name": "DENNIS",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY5975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "KOGUTEK",
            "middle_name": "DENNIS",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Psychologist in Tustin, CA
• Providers in Tustin, 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.