Provider Demographics
NPI:1043948797
Name:POON, MICHAEL C (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:POON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 12TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4299
Mailing Address - Country:US
Mailing Address - Phone:516-639-6866
Mailing Address - Fax:
Practice Address - Street 1:1038 12TH ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4299
Practice Address - Country:US
Practice Address - Phone:516-639-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist