Provider Demographics
NPI:1215453279
Name:DUNSON, KYLE STEPHEN
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:STEPHEN
Last Name:DUNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 SILVER CREEK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1059
Mailing Address - Country:US
Mailing Address - Phone:408-574-9202
Mailing Address - Fax:510-569-4589
Practice Address - Street 1:5855 SILVER CREEK VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1059
Practice Address - Country:US
Practice Address - Phone:408-574-9202
Practice Address - Fax:408-574-9238
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA949191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical