Healthcare Provider Details

I. General information

NPI: 1457068892
Provider Name (Legal Business Name): RYAN TRUMAN WONG PHD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

IV. Provider business mailing address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94027197
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35309
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: