Healthcare Provider Details

I. General information

NPI: 1437288446
Provider Name (Legal Business Name): JOHN K KUA III CAARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 ILLINOIS ST SUITE 101
SAN DIEGO CA
92104-3058
US

IV. Provider business mailing address

3721 ARIZONA ST APT. A
SAN DIEGO CA
92104-3326
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2424
  • Fax: 619-255-4174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: