Provider Demographics
NPI:1457117079
Name:SIANGCO, JORDAN KALEONOHE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:KALEONOHE
Last Name:SIANGCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33779 DALTON CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3217
Mailing Address - Country:US
Mailing Address - Phone:510-320-7183
Mailing Address - Fax:
Practice Address - Street 1:33779 DALTON CT
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3217
Practice Address - Country:US
Practice Address - Phone:510-320-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst