DR. KENNETH HARTLINE PSY.D.
NPI 1114472180
Clinical Neuropsychologist in Los Angeles, CA

Q: What is Kenneth Hartline's NPI number?

The NPI number for Kenneth Hartline is 1114472180. It was assigned to this individual provider in the NPPES registry on August 19, 2016.

Q: What is Kenneth Hartline's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Q: When was this NPI record last updated?

The NPPES record for Kenneth Hartline was last updated on November 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 19, 2016PECOS Enrolled

444 S SAN VICENTE BLVD STE 103, LOS ANGELES, CA 90048(310) 423-9722 Get Directions Write a Review

NPPES record last updated: November 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 12, 2025, Aug 19, 2016 (2 updates tracked since 2016).

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About Dr. Kenneth Hartline Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KENNETH HARTLINE PSY.D. (NPI 1114472180) is an individual clinical neuropsychologist in Los Angeles, California, licensed in California (PSY28449) and active in the NPI registry since August 2016. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1114472180

Entity TypeIndividualMale

Primary Taxonomy103G00000X

Provider Legal NameDR. KENNETH HARTLINECredential: PSY.D.

Location Address444 S SAN VICENTE BLVD STE 103Los Angeles, CA 90048-4169

Mailing Address4140 W 190th StTorrance, CA 90504-5513

Phone(310) 423-9722

Sole ProprietorNo

Medical School CMSOtherGraduated 2015

Enumeration DateAugust 19, 2016

Last NPPES UpdateNovember 12, 20252 updates tracked since enumeration

NPPES CertifiedNovember 12, 2025

✔ NPI 1114472180 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers

Taxonomy Code103G00000X

License✔ Licensed in CA · PSY28449

Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

444 S SAN VICENTE BLVD STE 103, Los Angeles, CA 90048

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Secondary Practice Locations 2

Location 12070 Century Park E Ste P456Los Angeles, CA 90067-1907 · Phone (310) 423-9722

Location 28700 Beverly Blvd Ste 7409West Hollywood, CA 90048-1804 · Phone (310) 423-9722

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kenneth Hartline Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4486146651

PECOS Enrollment IDI20251125001209

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YI MIAO PHD

Psychologist (Clinical)