Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT19412 | CA |
NPI | 1851936546 |
---|---|
Provider Name | Jennifer Weiai Tai |
First Address | Los Gatos, CA 95030-6227 |
Second Address | Los Gatos, CA 95030-6227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2019 |
Last Update Date | 17/11/2019 |