Provider Demographics
NPI:1790661189
Name:KAO, VANESSA JASMINE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:JASMINE
Last Name:KAO
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 1:2775 MESA VERDE DR E APT Q104
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5011
Mailing Address - Country:US
Mailing Address - Phone:818-378-4637
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-475-5575
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB1405656106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician