Individual provider Active NPI

Kin Kyi Chavez

  • Occupational Therapy Assistant
  • San Leandro, CA
National Provider Identifier
1699389650
Registry record updated Sep 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA5350 Issued in CA
Practice address
14766 Washington Ave
San Leandro, CA 94578
Phone
(510) 352-2211
NPI assigned
Sep 6, 2020
Last updated
Sep 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA5350 CA Primary

Addresses

Primary practice location

14766 Washington Ave
San Leandro, CA 94578

Mailing address

3695 Stevenson Blvd Unit 312
Fremont, CA 94538-2375
Phone (201) 790-4398

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA5350CAMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1599350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599350400000",
    "number": "1699389650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3695 STEVENSON BLVD UNIT 312",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382375",
            "telephone_number": "201-790-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14766 WASHINGTON AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "94578",
            "telephone_number": "510-352-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "KIN",
        "middle_name": "KYI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-06",
        "last_updated": "2020-09-06",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "OTA5350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2020; 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.