Provider Demographics
NPI:1619742004
Name:AUGUST, KATHLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921A OPAL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2626
Mailing Address - Country:US
Mailing Address - Phone:510-499-0058
Mailing Address - Fax:
Practice Address - Street 1:2089 VALE RD STE 10
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3848
Practice Address - Country:US
Practice Address - Phone:510-831-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist