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100 S Ellsworth Ave Ste 802 San Mateo CA 94401-3926 | |
| (650) 667-7193 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 100 S Ellsworth Ave Ste 802, San Mateo, California |
| Authorized Official Name and Position | William Chan (PRESIDENT) |
| Authorized Official Contact | 6506677193 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
700 El Camino Real #1175 Suite 120 Menlo Park CA 94025 Ph: () - | 100 S Ellsworth Ave Ste 802 San Mateo CA 94401-3926 Ph: (650) 667-7193 |
| NPI Number | 1386336501 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386336501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
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