Individual
KY VY NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 GATEWAY BLVD FL 2, SOUTH SAN FRANCISCO, CA 94080-7401
(650) 573-4799
(650) 573-1023
Mailing address
801 GATEWAY BLVD FL 2, SOUTH SAN FRANCISCO, CA 94080-7401
(650) 573-4799
(650) 573-1023
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
08/25/2025
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