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General NPI Number Information
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NPI Number | 1861630022
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Entity Type | Individual
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Provider Name | SAMANTHA ARCHUSSACHAT KWON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 2008 MORSE AVE COMMONS BUILDING
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City | SACRAMENTO
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State | CA
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Zip | 95825-2135
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Country | US
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Telephone | 916-973-7502
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Fax | 916-973-7320
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Provider Business Mailing Address
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Address Line | 2008 MORSE AVE COMMONS BUILDING
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City | SACRAMENTO
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State | CA
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Zip | 95825-2135
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Country | US
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Telephone | 916-973-7502
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Fax | 916-973-7320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22089
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License Number State | CA
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