Healthcare Provider Details

I. General information

NPI: 1750829206
Provider Name (Legal Business Name): JOYCE KWOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2017
Last Update Date: 02/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 SHATTUCK AVE 2ND FLR.
BERKELEY CA
94709-1516
US

IV. Provider business mailing address

1442A WALNUT ST #310
BERKELEY CA
94709-1405
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-3695
  • Fax:
Mailing address:
  • Phone: 510-282-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAC 9053
License Number StateCA

VIII. Authorized Official

Name: JOYCE KWOK
Title or Position: OWNER
Credential:
Phone: 510-282-3695