Healthcare Provider Details

I. General information

NPI: 1891517967
Provider Name (Legal Business Name): KARIN M JINBO PPS, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MONTECITO AVE
MOUNTAIN VIEW CA
94043-4590
US

IV. Provider business mailing address

PO BOX 611507
SAN JOSE CA
95161-1507
US

V. Phone/Fax

Practice location:
  • Phone: 707-631-5115
  • Fax:
Mailing address:
  • Phone: 707-631-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220128476
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP4168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: