Healthcare Provider Details

I. General information

NPI: 1073157491
Provider Name (Legal Business Name): KWASI ADUSEI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 HILLVIEW ST
OAKLAND CA
94602-3333
US

IV. Provider business mailing address

1401 21ST ST
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 631-524-1522
  • Fax:
Mailing address:
  • Phone:
  • Fax: 631-986-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95355854
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number704361
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402811-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: