Healthcare Provider Details

I. General information

NPI: 1245717453
Provider Name (Legal Business Name): MATTHEW KINOSHITA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY STE 320
SANTA CLARA CA
95054-1140
US

IV. Provider business mailing address

30767 GATEWAY PL
RANCHO MISSION VIEJO CA
92694-1856
US

V. Phone/Fax

Practice location:
  • Phone: 949-233-5332
  • Fax:
Mailing address:
  • Phone: 949-233-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1016
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number78006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: