Individual
DR. KENNETH MARK WOOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
23591 EL TORO RD, SUITE 104, LAKE FOREST, CA 92630-4774
(949) 422-4120
(949) 296-0398
Mailing address
22365 EL TORO RD, PMB 271, LAKE FOREST, CA 92630-5053
(949) 422-4120
(949) 296-0398
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PSY20560
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY20560
CA
103TF0000X
Family Psychologist
PSY20560
CA
Other
Enumeration date
11/20/2006
Last updated
05/19/2010
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