Healthcare Provider Details

I. General information

NPI: 1427367515
Provider Name (Legal Business Name): KENT SAETEURN B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

IV. Provider business mailing address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax: 510-530-8083
Mailing address:
  • Phone: 510-531-3111
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberD7025035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: