Individual
KENN NICHOLAS UNGAB TALAID
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
650 S BASCOM AVE, SAN JOSE, CA 95128-2601
(408) 261-7777
(408) 642-6052
Mailing address
1922 THE ALAMEDA, SAN JOSE, CA 95126-1457
(209) 594-7259
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41801
CA
Other
Enumeration date
07/22/2024
Last updated
07/26/2024
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