Healthcare Provider Details

I. General information

NPI: 1891141370
Provider Name (Legal Business Name): KATHLEEN J. DONG, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CAMBRIDGE AVE SUITE 200
PALO ALTO CA
94306-1550
US

IV. Provider business mailing address

350 CAMBRIDGE AVENUE SUITE 200
PALO ALTO CA
94306
US

V. Phone/Fax

Practice location:
  • Phone: 650-600-8863
  • Fax:
Mailing address:
  • Phone: 650-600-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberG059622
License Number StateCA

VIII. Authorized Official

Name: KATHLEEN DOMG
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 650-600-8862