MEDICARE: MS. LI TAK AGNES TUNG 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	LCS16142	CA

General Provider Information

NPI Number	:	1942492913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LI TAK AGNES TUNG LCSW

Provider Business Mailing Address
First Line	:	4527 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2603
Country	:	US
Telephone Number	:	415-337-4774
Fax Number	:	415-333-2058

Provider Business Practice Location Address
First Line	:	4527 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2603
Country	:	US
Telephone Number	:	415-337-4774
Fax Number	:	415-333-2058

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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