Provider Demographics
NPI:1427466549
Name:REGALIA, KYONG AE (LCS 26246)
Entity type:Individual
Prefix:
First Name:KYONG AE
Middle Name:
Last Name:REGALIA
Suffix:
Gender:F
Credentials:LCS 26246
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1367
Mailing Address - Country:US
Mailing Address - Phone:510-830-3929
Mailing Address - Fax:
Practice Address - Street 1:1955 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1367
Practice Address - Country:US
Practice Address - Phone:510-830-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical