Healthcare Provider Details

I. General information

NPI: 1366916991
Provider Name (Legal Business Name): KYLE CACOYANNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2672 BAYSHORE PKWY STE 1045
MOUNTAIN VIEW CA
94043-1015
US

IV. Provider business mailing address

2676 BIRCHTREE LN
SANTA CLARA CA
95051-6230
US

V. Phone/Fax

Practice location:
  • Phone: 650-862-7320
  • Fax:
Mailing address:
  • Phone: 408-390-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: