Provider Demographics
NPI:1235671793
Name:LYU, KEZIAH (PSYD)
Entity type:Individual
Prefix:
First Name:KEZIAH
Middle Name:
Last Name:LYU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 JUNCTION AVE # 642007
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1932
Mailing Address - Country:US
Mailing Address - Phone:408-833-8687
Mailing Address - Fax:
Practice Address - Street 1:2731 JUNCTION AVE # 642007
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1932
Practice Address - Country:US
Practice Address - Phone:408-539-1229
Practice Address - Fax:408-207-4365
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33817103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical