Active NPI
Michelle Tung Kwok, M.D.
- Psychiatry Physician
- San Mateo, CA
National Provider Identifier
1104905959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A84230
- Practice address
- 1510 Fashion Island Blvd
Suite 110
San Mateo, CA 94404-1596 - Phone
- (408) 421-5826
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A84230 | CA | Primary |
Addresses
Primary practice location
1510 Fashion Island Blvd
Suite 110
San Mateo, CA 94404-1596
Mailing address
1510 Fashion Island Blvd
Suite 110
San Mateo, CA 94404-1596
Phone (408) 421-5826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2019 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A84230 | CA | MD | Psychiatry Physician |
Interoperability endpoints
- mkwok141218@hisp.ehr.sutterhealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1104905959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1510 FASHION ISLAND BLVD",
"address_2": "SUITE 110",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944041596",
"telephone_number": "408-421-5826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 FASHION ISLAND BLVD",
"address_2": "SUITE 110",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944041596",
"telephone_number": "408-421-5826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWOK",
"first_name": "MICHELLE",
"middle_name": "TUNG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A84230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.