Provider Demographics
NPI:1275154783
Name:KINTSUGI TMS
Entity Type:Organization
Organization Name:KINTSUGI TMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-500-8833
Mailing Address - Street 1:24012 CALLE DE LA PLATA STE 430
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7623
Mailing Address - Country:US
Mailing Address - Phone:949-500-8833
Mailing Address - Fax:
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 430
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7623
Practice Address - Country:US
Practice Address - Phone:949-500-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477868578Medicaid