Healthcare Provider Details

I. General information

NPI: 1982128278
Provider Name (Legal Business Name): JADE SUYEMATSU PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 05/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E TEMPLE ST.
LOS ANGELES CA
90012
US

IV. Provider business mailing address

2108 N ST. #11965
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 213-253-2677
  • Fax:
Mailing address:
  • Phone: 310-222-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: