Healthcare Provider Details

I. General information

NPI: 1104663384
Provider Name (Legal Business Name): HEIDI Y. KWAN PHD PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 MAPLE ST STE 255
VENTURA CA
93003-9147
US

IV. Provider business mailing address

3585 MAPLE ST STE 255
VENTURA CA
93003-9147
US

V. Phone/Fax

Practice location:
  • Phone: 805-650-0657
  • Fax:
Mailing address:
  • Phone: 805-650-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HEIDI KWAN
Title or Position: PSYCHOLOGIST/PRESIDENT
Credential: PHD
Phone: 805-415-8468