MEDICARE: JESSIE THAING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1306311535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE THAING

Provider Business Mailing Address
First Line	:	1151 A ST
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94541-4113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4249 GEMINI DR
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4068
Country	:	US
Telephone Number	:	510-766-3085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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Directions to “ JESSIE THAING ” Practice Location

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