Healthcare Provider Details

I. General information

NPI: 1356274559
Provider Name (Legal Business Name): PENINSULA WELLNESS PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PRIMROSE RD
BURLINGAME CA
94010-4064
US

IV. Provider business mailing address

405 PRIMROSE RD STE 310
BURLINGAME CA
94010-4092
US

V. Phone/Fax

Practice location:
  • Phone: 650-520-1134
  • Fax: 888-557-9497
Mailing address:
  • Phone: 650-520-1134
  • Fax: 888-557-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LIN
Title or Position: CEO/FOUNDER
Credential: PSY.D.
Phone: 650-520-1134