Provider Demographics
NPI:1568595056
Name:HARDIN, KIMERON NORMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMERON
Middle Name:NORMAN
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2346
Mailing Address - Country:US
Mailing Address - Phone:650-743-7922
Mailing Address - Fax:866-885-2864
Practice Address - Street 1:2270 E PARK DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6542
Practice Address - Country:US
Practice Address - Phone:650-743-7922
Practice Address - Fax:866-885-2864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14326103TC0700X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS05255Medicare UPIN
CAOPL143261Medicare PIN