Provider Demographics
NPI:1194892208
Name:EASTON, JEREMY LUN HAO (MS)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:LUN HAO
Last Name:EASTON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1450
Mailing Address - Country:US
Mailing Address - Phone:650-862-8203
Mailing Address - Fax:
Practice Address - Street 1:913 WILLOW ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2380
Practice Address - Country:US
Practice Address - Phone:408-496-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 48684106H00000X
CAMFC48646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41787OtherCOUNTY ID