Provider Demographics
NPI:1720811151
Name:KUANG, JESSICA KAYAN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAYAN
Last Name:KUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 LA VEREDA RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2035
Mailing Address - Country:US
Mailing Address - Phone:619-623-2902
Mailing Address - Fax:
Practice Address - Street 1:101 CALLAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4523
Practice Address - Country:US
Practice Address - Phone:510-547-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker