Healthcare Provider Details

I. General information

NPI: 1659857340
Provider Name (Legal Business Name): MR. KAIHAN ZHONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BROADWAY (KAISER PERMANENTE-PSYCHIATRY)
VALLEJO CA
94589-2226
US

IV. Provider business mailing address

1761 BROADWAY
VALLEJO CA
94589-2226
US

V. Phone/Fax

Practice location:
  • Phone: 650-933-4030
  • Fax:
Mailing address:
  • Phone: 415-818-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: