Healthcare Provider Details

I. General information

NPI: 1881789493
Provider Name (Legal Business Name): QUYEN TIET PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 SHERWOOD AVE
LOS ALTOS CA
94022-1376
US

IV. Provider business mailing address

60 S EL MONTE AVE
LOS ALTOS CA
94022
US

V. Phone/Fax

Practice location:
  • Phone: 650-906-5134
  • Fax:
Mailing address:
  • Phone: 650-947-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: