MEDICARE: GRACELIN KAMKONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1053262568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACELIN KAMKONG

Provider Business Mailing Address
First Line	:	268 BUSH ST STE 3039
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-3503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5335 COLLEGE AVE STE 21
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-2804
Country	:	US
Telephone Number	:	888-362-3970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ GRACELIN KAMKONG ” Practice Location

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