Provider Demographics
NPI:1134740509
Name:BOND, DAVID KYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KYLE
Last Name:BOND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3334 E COAST HWY # 509
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2328
Mailing Address - Country:US
Mailing Address - Phone:480-329-0544
Mailing Address - Fax:
Practice Address - Street 1:4063 BIRCH ST STE 220
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2241
Practice Address - Country:US
Practice Address - Phone:480-329-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY31794OtherPSYCHOLOGY LICENSE