Provider Demographics
NPI:1174004394
Name:KAYWIN, RALPH MATHEW (DMH)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MATHEW
Last Name:KAYWIN
Suffix:
Gender:M
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 COLLEGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1653
Mailing Address - Country:US
Mailing Address - Phone:510-849-9312
Mailing Address - Fax:
Practice Address - Street 1:5835 COLLEGE AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1653
Practice Address - Country:US
Practice Address - Phone:510-849-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9018103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist