Provider Demographics
NPI:1427582212
Name:TERNIAN, KALIN
Entity Type:Individual
Prefix:
First Name:KALIN
Middle Name:
Last Name:TERNIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 PARK AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2913
Mailing Address - Country:US
Mailing Address - Phone:888-427-8689
Mailing Address - Fax:888-427-8689
Practice Address - Street 1:1190 PARK AVE UNIT B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2913
Practice Address - Country:US
Practice Address - Phone:888-427-8689
Practice Address - Fax:888-427-8689
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA015880315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)