Healthcare Provider Details

I. General information

NPI: 1790648723
Provider Name (Legal Business Name): EDWIN WEN CO PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W 6TH ST
LOS ANGELES CA
90057-3113
US

IV. Provider business mailing address

2801 W 6TH ST
LOS ANGELES CA
90057-3113
US

V. Phone/Fax

Practice location:
  • Phone: 213-867-6300
  • Fax: 323-836-0861
Mailing address:
  • Phone: 213-867-6300
  • Fax: 323-836-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240325235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: