Healthcare Provider Details

I. General information

NPI: 1154465821
Provider Name (Legal Business Name): KAO C SYVIRATHPHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BRESLAUER WAY
REDDING CA
96001-4246
US

IV. Provider business mailing address

5480 CEDARS RD
REDDING CA
96001-4454
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-5200
  • Fax:
Mailing address:
  • Phone: 530-215-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: