Healthcare Provider Details

I. General information

NPI: 1346166402
Provider Name (Legal Business Name): KAIN JOSEPH GONZALEZ MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 MARIE P DEBARTOLO WAY
SANTA CLARA CA
95054-1156
US

IV. Provider business mailing address

500 MANSION CT APT 211
SANTA CLARA CA
95054-3560
US

V. Phone/Fax

Practice location:
  • Phone: 408-562-4949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000057319
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: