Healthcare Provider Details

I. General information

NPI: 1750524427
Provider Name (Legal Business Name): GERALD PUK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDDLEFIELD RD # 208
PALO ALTO CA
94301-2124
US

IV. Provider business mailing address

555 MIDDLEFIELD RD # 208
PALO ALTO CA
94301-2124
US

V. Phone/Fax

Practice location:
  • Phone: 650-328-5821
  • Fax: 650-508-9099
Mailing address:
  • Phone: 650-328-5821
  • Fax: 650-508-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 10704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006074-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: