Healthcare Provider Details

I. General information

NPI: 1669825675
Provider Name (Legal Business Name): ICARUS KWOK TSANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 GELLERT BLVD
DALY CITY CA
94015-2611
US

IV. Provider business mailing address

386 GELLERT BLVD
DALY CITY CA
94015-2611
US

V. Phone/Fax

Practice location:
  • Phone: 650-761-3500
  • Fax: 650-761-3580
Mailing address:
  • Phone: 650-761-3500
  • Fax: 650-761-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: