| Doctor Name: | MS. KIMBERLY ANNE TANGEN |
| NPI Number: | 1073796058 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 22865 |
| Business Practice Address: | 4001 King Ave Corcoran, CA - 93212 |
| Business Phone Number: | 5599928800 |
| Business Fax Number: | 5599929409 |
| Mailing Address: | Po Box 8800, CORCORAN |
| State: | CA |
| Postal Code: | 932128309 |
| Phone Number: | 5599928800 |
| Fax Number: | 5599929409 |
| NPI Enumeration Date: | 12/12/2007 |
| NPI Last Update Date: | 12/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 22865 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |