Healthcare Provider Details

I. General information

NPI: 1831580141
Provider Name (Legal Business Name): KATHERINE TJHIN-KEOPHIPHAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD STE 1400
SACRAMENTO CA
95816-5263
US

IV. Provider business mailing address

3160 FOLSOM BLVD STE 1400
SACRAMENTO CA
95816-5263
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-1831
  • Fax:
Mailing address:
  • Phone: 916-731-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30091
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030708
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: