Healthcare Provider Details

I. General information

NPI: 1235671793
Provider Name (Legal Business Name): KEZIAH LYU PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 POLARIS AVE STE 11
MOUNTAIN VIEW CA
94043-4579
US

IV. Provider business mailing address

229 POLARIS AVE STE 11
MOUNTAIN VIEW CA
94043-4579
US

V. Phone/Fax

Practice location:
  • Phone: 408-539-1229
  • Fax:
Mailing address:
  • Phone: 408-539-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: