Kimberly Marie Hagan, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15282 Issued in CA

Practice address

2228 N State College Blvd
Fullerton Counseling & Medical Group Inc
Fullerton, CA 92831

Phone

(714) 990-0700

Fax

(714) 990-0142

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2021 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fullerton Counseling and Medical Group, Inc

  • Prescribing (Medical) Psychologist
  • Fullerton, CA
  • NPI 1821131673
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861584922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2228 N STATE COLLEGE BLVD",
            "address_2": "FULLERTON COUNSELING & MEDICAL GROUP INC",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92831",
            "telephone_number": "714-990-0700",
            "fax_number": "714-990-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2228 N STATE COLLEGE BLVD",
            "address_2": "FULLERTON COUNSELING & MEDICAL GROUP INC",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92831",
            "telephone_number": "714-990-0700",
            "fax_number": "714-990-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordon Elwood Haag Jr., D.D.S.
• Jason Michael Haakinson, PHARMD
• Arnold Ryan Haban
• Peter Habib
• Giorgio Joseph Haddad
• Aaron Joseph Hageman
• Hannah Hahn
• Nargis Ali Haidary
• Leila Hajkazemshirazi
• Danielle Halewijn

• Clinical Psychologist in Fullerton, CA
• Providers in Fullerton, 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.