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: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 VAN NESS AVE
SAN FRANCISCO CA
94109-3370
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6200
  • Fax:
Mailing address:
  • Phone: 415-600-6200
  • Fax:

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: