Kenneth Mark Woog, PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY20560 Issued in CA

Practice address

23591 El Toro Rd
Suite 104
Lake Forest, CA 92630-4774

Phone

(949) 422-4120

Fax

(949) 296-0398

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274227200000",
    "number": "1437223245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22365 EL TORO RD",
            "address_2": "PMB 271",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926305053",
            "telephone_number": "949-422-4120",
            "fax_number": "949-296-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23591 EL TORO RD",
            "address_2": "SUITE 104",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926304774",
            "telephone_number": "949-422-4120",
            "fax_number": "949-296-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOG",
        "first_name": "KENNETH",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2010-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY20560",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY20560",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "PSY20560",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francis Y Wong, M.D
• Tracy Wood
• Sheryl Elizabeth Woodhouse, LMFT
• Esther Woodward
• Debra Woog, LMFT
• Workscript Mail Order Pharmacy LLC
• Anhtu Wu
• Carly Wulffert
• Brooke Wyatt, MS, RDN, CSSD
• Taylor Wyatt

• Clinical Child & Adolescent Psychologist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Clinical Child & Adolescent Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; 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.

Verify at the official NPI Registry.