Provider Demographics
NPI:1508246117
Name:CHU, KA KEI DIANA
Entity Type:Individual
Prefix:
First Name:KA KEI DIANA
Middle Name:
Last Name:CHU
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 1:1600 BRYANT STREET,
Mailing Address - Street 2:PO #410811
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141-9991
Mailing Address - Country:US
Mailing Address - Phone:415-937-3956
Mailing Address - Fax:
Practice Address - Street 1:3345 17TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-7211
Practice Address - Country:US
Practice Address - Phone:415-937-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT105546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist