Provider Demographics
NPI:1144594748
Name:KWOK, XENIA TSZ-SHAN
Entity Type:Individual
Prefix:
First Name:XENIA
Middle Name:TSZ-SHAN
Last Name:KWOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CORPORATE CENTER DR STE 350
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7620
Mailing Address - Country:US
Mailing Address - Phone:323-526-4016
Mailing Address - Fax:323-526-4096
Practice Address - Street 1:3924 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-6611
Practice Address - Country:US
Practice Address - Phone:951-416-1111
Practice Address - Fax:951-346-3781
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist