Healthcare Provider Details

I. General information

NPI: 1457776726
Provider Name (Legal Business Name): HENTY KIO PAK MPA, ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 11/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST SUITE E1
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

271 ROSEWOOD CT
HAYWARD CA
94544-4731
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4646
  • Fax: 510-437-8313
Mailing address:
  • Phone: 510-885-0877
  • Fax: 510-437-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74288
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: