Healthcare Provider Details

I. General information

NPI: 1205742111
Provider Name (Legal Business Name): JESSICA KAIXIN WANG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SAN RAMON VALLEY BLVD STE 190
DANVILLE CA
94526-4032
US

IV. Provider business mailing address

5306 CRESTFIELD DR
SAN RAMON CA
94582-5364
US

V. Phone/Fax

Practice location:
  • Phone: 925-552-5787
  • Fax:
Mailing address:
  • Phone: 510-918-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: