Kyalai A Shaw, SUDRC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

16183 Issued in CA

Practice address

3845 Telegraph Ave
Oakland, CA 94609-2419

Phone

(510) 450-1197

NPI assigned

Aug 31, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Miss Kiki Shaw Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Horizon Services, Inc

  • Substance Abuse Rehabilitation Facility
  • Hayward, CA
  • NPI 1336325737
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1386312783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CONCORD AVE STE CONCORD",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945204915",
            "telephone_number": "510-268-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092419",
            "telephone_number": "510-450-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KYALAI",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "SUDRC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-31",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT-20-142531",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "16183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIKI",
            "last_name": "SHAW",
            "prefix": "MISS",
            "credential": "RBT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dominique D Shaw
• Elizabeth A. Shaw, DO
• Farrah Shaw
• Felicia Shaw
• Jason Shaw
• Maurice Shaw, LCSW
• Mykira Lnique Shaw, CNA
• Nan Shaw, LCSW
• Saudia Shaw
• Sharon Renee Shaw

• Addiction (Substance Use Disorder) Counselor in Oakland, CA
• Providers in Oakland, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.