Healthcare Provider Details

I. General information

NPI: 1316431810
Provider Name (Legal Business Name): DENNIS WANG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 W MAIN ST STE 100
ALHAMBRA CA
91801-1951
US

IV. Provider business mailing address

528 E LA SIERRA DR
ARCADIA CA
91006-4320
US

V. Phone/Fax

Practice location:
  • Phone: 626-248-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: