Provider Demographics
NPI:1700477338
Name:DR. KAN PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:DR. KAN PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN-TING
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, MSED
Authorized Official - Phone:925-238-8932
Mailing Address - Street 1:4760 MAHOGANY ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7672
Mailing Address - Country:US
Mailing Address - Phone:917-378-2284
Mailing Address - Fax:
Practice Address - Street 1:4695 CHABOT DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2756
Practice Address - Country:US
Practice Address - Phone:925-238-8932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty