MEDICARE: DR. MIMI WHEIPING LOU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 13923	CA

General Provider Information

NPI Number	:	1669697520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIMI WHEIPING LOU PH.D.

Provider Business Mailing Address
First Line	:	6355 TELEGRAPH AVE
Second Line	:	SUITE 302
City	:	OAKLAND
State	:	CA
Zip	:	94609-1371
Country	:	US
Telephone Number	:	510-652-5910
Fax Number	:	510-655-1004

Provider Business Practice Location Address
First Line	:	6355 TELEGRAPH AVE
Second Line	:	SUITE 302
City	:	OAKLAND
State	:	CA
Zip	:	94609-1371
Country	:	US
Telephone Number	:	510-652-5910
Fax Number	:	510-655-1004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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