Healthcare Provider Details

I. General information

NPI: 1124340906
Provider Name (Legal Business Name): KRISTEN KO-SHIN YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN KO-SHIN WANG

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N LAKE AVE SUITE 101
PASADENA CA
91104-2300
US

IV. Provider business mailing address

1460 N LAKE AVE SUITE 101
PASADENA CA
91104-2300
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-7710
  • Fax:
Mailing address:
  • Phone: 626-296-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: