Provider Demographics
NPI:1679303424
Name:KIM-HAYES, KASSINA
Entity type:Individual
Prefix:
First Name:KASSINA
Middle Name:
Last Name:KIM-HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 BRUNELL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-4106
Mailing Address - Country:US
Mailing Address - Phone:510-593-0851
Mailing Address - Fax:
Practice Address - Street 1:501 OLD COUNTY RD STE D
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2567
Practice Address - Country:US
Practice Address - Phone:650-701-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist