Healthcare Provider Details

I. General information

NPI: 1578947263
Provider Name (Legal Business Name): KA YI NG MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST ST COMMUNITY YOUTH CENTER
SAN FRANCISCO CA
94109-5603
US

IV. Provider business mailing address

652 STANYAN ST 304
SAN FRANCISCO CA
94117-1871
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 510-990-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF93985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: