Healthcare Provider Details

I. General information

NPI: 1184826323
Provider Name (Legal Business Name): CEPHAS WONG LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16056 SIERRA PASS WAY
HACIENDA HTS CA
91745-6544
US

IV. Provider business mailing address

PO BOX 1277
MONTEREY PARK CA
91754-8277
US

V. Phone/Fax

Practice location:
  • Phone: 909-282-3257
  • Fax:
Mailing address:
  • Phone: 626-284-4202
  • Fax: 626-828-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMFC31771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: