Provider Demographics
NPI:1205047891
Name:TOM, DAVID TAI-WAI (MFTI)
Entity type:Individual
Prefix:MR
First Name:DAVID TAI-WAI
Middle Name:
Last Name:TOM
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22455 MAPLE CT
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4031
Mailing Address - Country:US
Mailing Address - Phone:510-582-0148
Mailing Address - Fax:510-582-8460
Practice Address - Street 1:22455 MAPLE CT
Practice Address - Street 2:SUITE 402
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4031
Practice Address - Country:US
Practice Address - Phone:510-582-0148
Practice Address - Fax:510-582-8460
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 41885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist