MEDICARE: MS. KRISTINE Y KWOK LCSW

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	1041C0700X	Clinical Social Worker	24872	CA

General Provider Information

NPI Number	:	1730108549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINE Y KWOK LCSW

Provider Business Mailing Address
First Line	:	3270 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4840
Country	:	US
Telephone Number	:	415-499-6804
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/03/2014

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