MEDICARE: TESSA KWAN

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	106H00000X	Marriage & Family Therapist	135202	CA

General Provider Information

NPI Number	:	1699482679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA KWAN

Provider Business Mailing Address
First Line	:	3182 CAMPUS DR # 128
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3123
Country	:	US
Telephone Number	:	650-933-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 FERNWOOD ST
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-4136
Country	:	US
Telephone Number	:	650-867-6486
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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Directions to “ TESSA KWAN ” Practice Location

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