Healthcare Provider Details

I. General information

NPI: 1306002050
Provider Name (Legal Business Name): PEGGY CHINGIN KWOK MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHING IN KWOK

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LA PULGAS
SAN MATEO CA
94403
US

IV. Provider business mailing address

1950 ALAMEDA DE LA PULGAS
SAN MATEO CA
94403
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 650-573-2408
  • Fax: 415-597-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC53519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF61072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: