Provider Demographics
NPI:1952132557
Name:KY, SHAINA SANG (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:SANG
Last Name:KY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:SANG
Other - Middle Name:TU
Other - Last Name:KY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3215 CORBAL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-3823
Mailing Address - Country:US
Mailing Address - Phone:408-316-7623
Mailing Address - Fax:
Practice Address - Street 1:3900 FREEDOM CIR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1222
Practice Address - Country:US
Practice Address - Phone:408-235-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist