Basic Information
| Provider Information | |||||||||
| NPI: | 1699389650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | KIN | ||||||||
| MiddleName: | KYI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3695 STEVENSON BLVD UNIT 312 | ||||||||
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| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017904398 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14766 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103522211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2020 | ||||||||
| LastUpdateDate: | 09/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA5350 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.