Provider Demographics
NPI:1457840761
Name:TSENG, KEVAN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KEVAN
Middle Name:
Last Name:TSENG
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18685 MAIN ST STE 101-459
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1723
Mailing Address - Country:US
Mailing Address - Phone:949-333-9914
Mailing Address - Fax:714-464-4555
Practice Address - Street 1:18685 MAIN ST STE 101-459
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1723
Practice Address - Country:US
Practice Address - Phone:714-697-1907
Practice Address - Fax:714-464-4555
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-29155103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst