Basic Information
| Provider Information | |||||||||
| NPI: | 1770674343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1277 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906091277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629066470 | ||||||||
| FaxNumber: | 5629469465 | ||||||||
| Practice Location | |||||||||
| Address1: | 15725 WHITTIER BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906032347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629471669 | ||||||||
| FaxNumber: | 5624645134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G52557 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G52557 | 01 | CA | LICENSE # | OTHER |