Provider Demographics
NPI:1861721672
Name:FORD, KIM AJLOUNY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:AJLOUNY
Last Name:FORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:AJLOUNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2351 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2009
Mailing Address - Country:US
Mailing Address - Phone:858-229-6986
Mailing Address - Fax:858-712-3881
Practice Address - Street 1:265 SANTA HELENA STE 214
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-480-1661
Practice Address - Fax:858-712-3881
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN